Objective? To evaluate the efficacy, safety, and effects on skin appearance and quality of life of levocetirizine hydrochloride tablets combined with medical wound care solution for dermatitis and eczema. Methods? Eighty-four patients with dermatitis and eczema from the dermatology department of our hospital (March–July 2026) were randomized into combination and control groups (42 each). The control group received oral levocetirizine hydrochloride tablets, while the combination group additionally received topical medical wound care solution, both for 4 weeks. Clinical symptom scores, response rate, skin barrier parameters [transepidermal water loss (TEWL), stratum corneum hydration], Dermatology Life Quality Index (DLQI) score, and skin appearance satisfaction were compared before and after 4 weeks of treatment. Adverse reactions and 6-month recurrence were recorded. Results? After 4 weeks, the combination group showed a higher overall response rate and greater relief of erythema, papules, exudation, and pruritus than the control group (P < 0.05). In the combination group, TEWL decreased from (38.74 ± 3.86) to (18.35 ± 1.87) g/(m2·h), and stratum corneum hydration increased from (23.41 ± 2.12)% to (46.62 ± 4.38)%, with significantly better skin barrier improvement than the control group (P < 0.05 for both). DLQI score decreased from (16.87 ± 2.34) to (3.26 ± 1.05) in the combination group, and skin appearance satisfaction was higher than that in the control group (P < 0.05). The incidence of adverse reactions was comparable between groups (P > 0.05). Conclusion? Levocetirizine hydrochloride tablets combined with medical wound care solution rapidly relieves symptoms, effectively repairs the skin barrier, improves skin appearance and quality of life, with good safety.