SAIGE I: Staphylococcus aureus, Immunological, Genetic, and Environmental (SAIGE) Factors Contributing to Atopic Dermatitis and the Use of Ceramide-Containing Skincare
October 2025 | Volume 24 | Issue 10 | 8591 | Copyright © October 2025
Published online September 30, 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
dDr. 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
fNorthwestern University Feinberg School of Medicine, Chicago, IL
gSeattle Children's Hospital; University of Washington School of Medicine Seattle, WA
hMount Sinai West and Mount Sinai Beth Israel, New York, NY
Abstract
Background: Atopic dermatitis (AD) is a common heterogeneous disorder that typically starts in infancy and early childhood, is associated with the development of comorbidities, and may persist into adulthood. Skin barrier dysfunction is a pivotal contributor to AD and is impacted by S. aureus colonization and immunological, genetic, and environmental (SAIGE) factors. Managing AD in clinical practice remains challenging due to multiple contributing SAIGE factors.
Methods: A global expert panel of 7 pediatric dermatologists and dermatologists used a modified Delphi process comprising face-to-face discussions and an online follow-up to define five consensus statements providing recommendations based on the literature, clinical experience, and the panel’s opinion for healthcare providers treating pediatric patients with AD.
Results: The panel defined SAIGE factors that compromise skin barrier function and contribute to AD development. The recommendations focus on the impact of SAIGE factors in pediatric AD development, reducing exposure to modifiable risk factors to mitigate skin barrier dysfunction. Continuous skincare that is initiated from birth may delay and mitigate AD, specifically in high-risk populations.
Conclusions: According to panel consensus, recognizing and mitigating SAIGE factors and initiating ceramide-containing skincare from birth are important. The panel recommendations underscore the need for clinician education to improve knowledge of the impact of SAIGE factors and therapeutic mitigation strategies to delay flare development and reduce AD severity.
INTRODUCTION
Atopic dermatitis (AD) is a chronic inflammatory skin disease typically with onset in infancy or early childhood and may persist into adulthood, with a prevalence of up to 20% in the pediatric population.1,2 It remains unclear if AD is a single disease or a spectrum of diseases with a shared phenotype.3 Certain clinical features are highly characteristic of AD, including eczematous lesions, xerosis, pruritus, relapsing course, and inherited atopy.1,3,4 AD is associated with pruritus, sleep disturbance, and reduced quality of life (QoL).1,2,4 AD has the highest disease burden among skin disorders globally and is associated with an 8.3-year reduction in lifespan and $250 million in healthcare costs in the United States.5,6
Despite advances in topical and systemic AD treatment options, challenges persist in AD management, leading to substantial disease impact on patients and caregivers.7 Approximately 2 million outpatient visits annually are due to AD, where dermatologist visits are more frequent for chronic AD, and primary care physician (PCP) visits are more frequent for acute AD, particularly in pediatric patients less than four years old.7,8 AD has a profound impact on pediatric patients as well as secondary effects on caregivers, highlighting the need for improved AD management and disease control, especially in pediatric patients.9
