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| Domain | Statement | Consensus percentage (%) |
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| The diagnosis and severity assessment of AD | (1) AD is commonly encountered by pediatricians and dermatologists; nonetheless, it is still under-recognized in its early stage in Saudi Arabia. Thus, an expert dermatologist should be involved in the assessment of suspected children with a family history of atopy, particularly in patients with isolated lesions | 100 |
| (2) AD diagnosis should be documented, showing the criteria used, key morphological characteristics, and features used to ascertain the severity of the disease. Nonetheless, there is still a need for simple validated diagnostic criteria for pediatric AD suitable for daily practice | 100 |
| (3) The use of available disease severity scales and QoL scale is under-utilized in routine Saudi practice, owing to their complexity and time-consuming nature. Although global assessment scores have not been validated in office settings, they can be used for the simple classification of AD severity | 100 |
| (4) Clinicians should examine the impact of disease on QoL during clinic visits. There is a need for validated Arabia patient-reported outcomes to measure the impact of AD on the QoL of the patients and their parents/caregivers | 100 |
| (5) Although lab tests and biomarkers can be used initially in the diagnosis of AD, there is no need for biomarkers for assessing the severity of AD | 75 |
| (6) Although AD is primarily a clinical diagnosis, many unrequired tests are usually ordered by the healthcare providers in the Saudi setting, despite the lack of sufficient data to support their diagnostic and/or prognostic utility | 100 |
| (7) The development and utilization of severity scores, with validated thresholds for treatment choice, are critical steps as the treatment’s decision is mainly based on disease severity | 92 |
| AD treatment | (8) There is a discrepancy between dermatologists, pediatricians, allergists, immunologists, and family physicians in managing atopic dermatitis in children | 92 |
| (9) The treatment of pediatric AD should be based on shared decision-making between the parents/caregivers and the provider. Educational programs for parents and health care providers are an important element of shared decision-making | 100 |
| (10) The shared decision-making should involve the following: | |
| (i) Treatment goals and expectations | 100 |
| (ii) Strategy planned to reach these goals | 91 |
| (iii) Therapeutic options | 100 |
| (iv) Risks and benefits | 100 |
| (v) The impact of associated comorbidities | 91 |
| (vi) Parents’ preference | 92 |
| (11) In the local Saudi setting, therapeutic protocols are still lacking. These protocols should incorporate | |
| (i) Therapeutic goals (endpoints, time points) | 100 |
| (ii) Criteria for eligibility for topical therapies, including nonsteroidal topical therapies | 91 |
| (iii) Criteria for monitoring response to systemic treatments | 100 |
| (12) The long-term management of pediatric AD is still challenging, owing to the variability in efficacy of available therapies in different patients’ profiles and the remittent-relapsing course of the disease | 100 |
| (13) Severe AD in children is likely to persist in adolescence and adulthood | |
| A long-term curative strategy including patient education, trigger avoidance, proper skincare, and compliance to pharmacologic therapies and nonpharmacologic measures is essential | 100 |
| (14) Many children with moderate-to-severe AD are not receiving systemic therapy because of a lack of recommendations concerning indication and appropriate timing of systemic treatments | |
| The introduction of systemic therapies is usually delayed, which impacts the response to therapy | 91 |
| (15) Systemic steroids are effective but are associated with unacceptable short- and long-term adverse events and, therefore, should be used with caution and in very limited circumstances for severe exacerbations for a short course | 100 |
| (16) Because of safety concerns, many immunosuppressive treatments (such as azathioprine, cyclosporine, and methotrexate) are not recommended for long-term use in children with AD. Insufficient data exist to make clear recommendations regarding the optimal immunosuppressants dosing or duration | 91 |
| (17) The limited number of approved therapies does not allow the development of a therapeutic algorithm | 92 |
| (18) The introduction of new biologic therapies will likely allow for improved treatment of pediatric AD and attempt to address the unmet needs of AD treatment in this population | 91 |
| (19) Real-world data and local experience with new biologic therapies are necessary to evidently support the use of biologics for indicated patients | 91 |
| (20) A considerable proportion of children with AD in Saudi Arabia do not adequately comply with the prescribed treatment. As most treatments are administrated at home with little hospital services involvement, there remain significant challenges in ensuring optimal treatment compliance | 91 |
| (21) The chronicity and necessity for multiple treatment vehicles may add to the complexity of treatment and barriers to adherence | 100 |
| (22) In Saudi Arabia, parents’ concerns over the safety profiles of topical and systemic therapies can lead to compliance issues and treatment delays or restrictions | 91 |
| (23) Corticophobia is a real issue in Saudi Arabia and needs to be promptly recognized and overcome by patient education programs | 100 |
| (24) Other factors that contribute to limited compliance in Saudi Arabia include the financial burden of long-term treatment and limited awareness among parents/caregivers | 82 |
| (25) Various strategies should be examined to improve adherence to topical treatment, such as telemedicine technology and proactive intermittent treatment strategies | 91 |
| (26) There is a need to develop unified validated criteria for assessing treatment response in pediatric AD, as there are no accepted criteria for defining treatment failure | 100 |
| (27) There is no consensus regarding the optimal treatment duration to demonstrate the efficacy of topical treatments for AD | 91 |
| (28) There are currently no acceptable biomarkers that would predict response to treatment in the setting of pediatric AD | 100 |
| Education and research of AD | (29) Educational measures are critical components of any treatment strategy for AD. These measures should be tailored according to patient- and disease-specific factors. Possible educational tools include using traditional materials, support groups, and mobile apps | 100 |
| (30) Educational interventions should also be directed at improving adherence to therapy and the utility of distraction techniques for the itch. A variety of educational interventions are possible. These can include face-to-face education in the clinic and workshops, online materials, and social media | 100 |
| (31) The education measures should aim to inform parents/caregivers about symptoms and signs of bacterial infection of AD: weeping, pustules, crusts, eczema failing to respond to treatment, rapidly worsening eczema, fever, and malaise | 91 |
| (32) Written care plans should cover treatment of flares and episodes of infected eczema to educate parents/caregivers on when topical corticosteroids (and other treatments) are appropriate | 100 |
| (33) In Saudi’s routine practice, there is limited awareness and utilization of validated diagnostic criteria. Thus, awareness campaigns should be promoted to target the knowledge of primary care providers and pediatricians about the diagnostic criteria for AD | 100 |
| (34) There is a limited number of published literature that investigates pediatric AD in Saudi Arabia. Future studies should focus on evaluating the epidemiology, risk factors, and diagnostic pathways for AD in the kingdom, as well as patients’ responses to treatment | 100 |
| (35) The absence of high-quality data indicates the need for more country-based research investigating the awareness, treatment, adherence, and control of symptoms amongst AD patients in Saudi Arabia | 100 |
| (36) Future studies should evaluate the reasons behind the delayed diagnosis of pediatric AD in Saudi Arabia and primary care physicians’ preparedness to deal with AD patients | 100 |
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| Impact of AD on caregivers | (37) Caring for children affected by AD can be an extremely time-consuming task that can impair personal relationships, decrease psychosocial functioning, cause sleep loss, and absence from work among family members of affected patients. Early intervention and psychotherapy are recommended to address these QoL impairments AD | 91 |
| (38) Physicians need to specifically ask about QoL impairments to fully understand the toll that AD takes on patients and their families. Family QoL instruments, such as the shortened 10-question dermatitis family impact questionnaire, can be used to evaluate these effects when available | 91 |
| (39) In the multidisciplinary approach with severe patients psychiatrists may be involved to provide therapy and education on parenting strategies to help caregivers | 92 |
| (40) Nonprofitable organizations and dermatological societies can play a role in providing psychological support and education to help caregivers | 100 |
| (41) Multidisciplinary education programs are needed to provide education and support for caregivers of patients with AD | 91 |
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| Patient journey and criteria for early referral | (42) A large proportion of AD patients in Saudi Arabia are managed directly by primary care physicians and pediatricians. Thus, knowledge of management guidelines, appropriate use of laboratory testing, and proper specialist referrals are crucial | 100 |
| (43) In Saudi Arabia, only a small portion of AD patients are referred early to dermatology clinics. There is limited practical knowledge among healthcare providers and general practitioners about the early referral of pediatric AD patients | 92 |
| (44) Typically, pediatric patients with AD are referred only upon severe diseases and no response to topical treatment. Early referral to a skilled dermatologist may improve the outcome of the patients before the development of severe AD | 100 |
| (45) In Saudi Arabia, healthcare providers are encouraged to refer children with allergic dermatitis, who had a family history of atopy, upon the presence of the following: | |
| (i) If the atopic eczema is severe and has not responded to optimal topical therapy | 100 |
| (ii) If treatment of bacterially infected ectopic eczema has failed | 73 |
| (iii) The diagnosis is or has become uncertain | 82 |
| (iv) Contact allergic dermatitis is suspected | 82 |
| (v) Atopic eczema gives rise to serious social or psychological problems for the child | 91 |
| (vi) Management has not controlled atopic eczema satisfactory according to a subject | 91 |
| (46) Pediatricians should urgently refer AD patients if eczema herpeticum is suspected | 91 |
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