SAIGE II: The Role of Staphylococcus aureus in Skin Barrier Dysfunction and the Development and Severity of Atopic Dermatitis in Young Children

August 2025 | Volume 24 | Issue 8 | 810 | Copyright © August 2025


Published online July 31, 2025

Lawrence A. Schachner MD FAAD FAAPa, Anneke Andriessen PhDb, Latanya Benjamin MD FAAD FAAPc, Mercedes E Gonzalez MD FAADd, Pearl Kwong MD FAAD FAAPe, Peter Lio MD FAADf, Robert Sidbury MD MPHg, Nanette B. Silverberg MD FAADh

aDermatology and Pediatrics, Pediatric Dermatology, University of Miami School of Medicine, Miami, FL
bRadboud Academy; Radboud UMC, Nijmegen and Andriessen Consultants Malden, The Netherlands
cYoung Skin MD, Florida Atlantic University, Parkland, FL
dPediatric Skin Research, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery at the University of Miami Miller School of Medicine, Miami, FL
eApex Clinical Trials/Suncoast Skin Solutions, Jacksonville, FL
fDepartment of Dermatology & Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
gDivision of Dermatology; Department of Pediatrics, Seattle Children's Hospital; University of Washington School of Medicine, Seattle, WA
hPediatric Dermatology, Mount Sinai Health System, Departments of Dermatology, Mount Sinai West and Mount Sinai Beth Israel, New York, NY

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. S. aureus colonization and a 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.

INTRODUCTION

Atopic dermatitis (AD) is a chronic inflammatory skin condition that often emerges in infancy or early childhood, affecting up to 20% of children and potentially continuing into adulthood.1 It remains uncertain whether AD represents a singular condition or a spectrum of disorders with similar manifestations. The hallmark clinical features of pediatric AD include a relapsing course with eczematous lesions, xerosis, intense pruritus, and a genetic predisposition to atopy.2 

Despite advancements in both topical and systemic therapies, managing pediatric AD effectively remains challenging, leading to substantial impacts on patients and caregivers.2 Indeed, annual AD outpatient visits have risen to nearly 2 million, with chronic cases more frequently seen by dermatologists and acute cases, especially in children under 4, more often managed by primary care physicians.2,3 This underscores the need for enhanced AD treatments and disease management, particularly for pediatric patients, as well as continuous education for pediatric healthcare providers.

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