Unmet Medical Needs and Early Referral of Pediatric Atopic Dermatitis: An Expert Modified Delphi Consensus from Saudi Arabia

Abstract

Atopic dermatitis (AD) is a chronic skin disease with increasing prevalence worldwide. It is characterized by pruritic eczematous lesions, affecting up to 20% of the children and negatively impacting their quality of life. Guidelines for AD management are available worldwide, but specific guidelines for pediatric AD in Saudi Arabia are lacking. This consensus document aims to identify the needs for the diagnosis and management of pediatric AD in Saudi Arabia by gathering the opinions and recommendations of key experts. We conducted a three-step modified Delphi method to develop the present consensus. The experts agreed that pediatricians and dermatologists commonly encounter AD; however, it is still under-recognized in its early stage in Saudi Arabia. The family physicians should be involved in assessing suspected children with a family history of atopy, particularly in patients with isolated lesions. Further, the experts confirmed that AD diagnosis should be documented, showing assessment criteria used, key morphological characteristics, and features used to ascertain the severity of the disease. There is still a need for simple validated diagnostic criteria suitable for daily practice for pediatric AD. The experts highlighted several medical conditions that pertain to the diagnosis and management of AD in Saudi Arabia.

Daily emollient throughout infancy to prevent eczema

“…A frequent childhood ailment that may persist into adulthood is eczema. Kids with eczema are prone to develop food allergies, asthma, & allergic rhinitis.. (Alradaddi et al, 2022). Due to the close relationship between early-onset eczema & food allergies, preventing dermatitis may help prevent food allergies.…”

The prevalence of atopic dermatitis and the effect of breastfeeding on atopic dermatitis among Saudi infants aged up to six months in the Al Madinah region

“…A study conducted in the United States found that longer EBF was associated with a lower risk of AD (OR 0.89 per month; 95% CI 0.82-0.97). 8 A study conducted in Japan found that EBF for at least six months was associated with a lower risk of AD (OR 0.70; 95% CI 0.52-0.93). 9 While the protective effect of breastfeeding against AD has been reported in many studies, there is limited research on this topic in Saudi Arabia, particularly in the Al Madinah region (AL-Hijaz area of Western Saudi Arabia).…”

“…IgA also modulates the gut microbiota, which is thought to be involved in the development of AD. 8 However, the evidence for this association is inconsistent, and few studies have examined this association among Saudi infants.…”