SAIGE III: The Role of Environmental Factors in the Development and Severity of Atopic Dermatitis in Young Children
October 2026 | Volume 25 | Issue 10 | 935 | Copyright © October 2026
Published online September 29, 2026
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 MPg†, Vanja Adzovic PharmDh, Nanette B. Silverberg MD MPH FAADi
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,
University of Miami Miller School of Medicine, Miami, FL
eApex Clinical Trials/Suncoast Skin Solutions, Jacksonville, FL
fDepartment of Dermatology and 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
hClinical Pharmacist, Blue Quill Communications, Toronto, Canada
iPediatric Dermatology, Mount Sinai Health System, Site Director of Pediatric and Adolescent Dermatology,
Departments of Dermatology and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY,
Abstract
Background: Atopic dermatitis (AD) often manifests in infancy or early childhood, with significant impacts on quality of life and potential persistence into adulthood. Environmental factors are key contributors to pruritus, barrier dysfunction, and inflammation associated with AD.
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 environmental factors that affect skin barrier function and contribute to the development and severity of pediatric AD. Consensus recommendations emphasize minimizing environmental exposures and highlight strategies to reduce skin barrier disruption. Early and continuous use of gentle, non-alkaline cleansers and ceramide-containing moisturizers, initiated from birth, may help mitigate AD risk and severity, particularly in high-risk children.
Conclusions: Recognizing and addressing environmental factors is an important component of pediatric AD management. Addressing modifiable environmental factors and initiating early barrier-supportive skincare, including ceramide-containing moisturizers, represents a practical approach to reducing disease severity and flare development. These findings highlight the importance of clinician education to improve awareness of environmental risk factors and effective mitigation strategies.
INTRODUCTION
Atopic dermatitis (AD) is a chronic inflammatory skin condition that typically begins in infancy, peaks in early childhood, and persists into adulthood.1,2 Clinical features of pediatric AD include a relapsing course with eczematous lesions, xerosis, intense pruritus, and a genetic predisposition to atopy.1 AD affects up to 20% of the pediatric population, and prevalence rates are expected to continue increasing, with published prevalence rates likely an underestimation.1,3 Pediatric AD significantly impacts affected children and caregivers and has been associated with an increased risk of attention deficit hyperactivity disorder (ADHD).1,4 The early disease onset and significant patient burden highlight the importance of early prevention and management strategies.
