Atopic dermatitis (AD) is a global concern marked by inflammation, skin barrier dysfunction, and immune dysregulation. Current treatments primarily address symptoms without offering a cure, underscoring the need for innovative therapeutic approaches. Mesenchymal stromal cell-derived extracellular vesicles (MSC-EVs) have attracted attention for their potential in immunomodulation and tissue repair, similar to their parent cells. This review provides a comprehensive analysis of the current landscape of MSC-EV research for AD management. We identified 12 studies that met our predefined inclusion criteria. We thoroughly reviewed both human and animal studies, analyzing aspects such as the source, isolation, and characterization of MSC-EVs, as well as the animal and disease models, dosage strategies, efficacy, mechanisms, and adverse effects. While this review highlights the promising potential of MSC-EV therapy for AD, it also emphasizes significant challenges, including heterogeneity and insufficient reporting. Given that this research area is still in its early stages, addressing these uncertainties will require collaborative efforts among researchers, regulatory bodies, and international societies to advance the field and improve patient outcomes.