Abstract
Background: Atopic dermatitis (AD) is a chronic inflammatory skin condition that often manifests in infancy or early childhood, with significant impacts on quality of life and potential persistence into adulthood. Staphylococcus aureus (S. aureus) colonization and complex interplay of immunological, genetic, and environmental (SAIGE) factors are key contributors to AD pathogenesis. In pediatric patients, the S. aureus colonization induces pruritus, barrier dysfunction, and inflammation, making AD management particularly challenging. Methods: A panel of 7 pediatric dermatology experts employed a modified Delphi process, including a face-to-face meeting and online follow-up, to evaluate current evidence and formulate consensus recommendations for managing pediatric AD. Results: The panel identified 6 consensus statements emphasizing S. aureus as a critical contributor to pruritus, skin barrier dysfunction, and AD exacerbation, reinforcing the need for effective, early skincare strategies. Recommendations include mitigating SAIGE factors, particularly S. aureus, through the proactive use of ceramide-containing skincare from birth in high-risk infants to delay and potentially prevent AD onset. Conclusions: The consensus panel highlighted S. aureus as the most critical SAIGE factor in pediatric AD pathogenesis, driving the itch-scratch-inflammation cycle and contributing to disease exacerbation. Consensus recommendations underscore the role of early, targeted skincare in pediatric AD management to reduce S. aureus impact on the skin barrier and support the need for clinician education on SAIGE factors and therapeutic strategies that mitigate AD progression and severity.