Narrative review on the management of moderate-severe atopic dermatitis in pediatric age of the Italian Society of Pediatric Allergology and Immunology (SIAIP), of the Italian Society of Pediatric Dermatology (SIDerP) and of the Italian Society of Pediatrics (SIP)

Table 10 Flow chart for the possible multidisciplinary management of pediatric moderate-severe atopic dermatitis in italy

	Healthcare facility	Actor	Action
Phase 1	General Practice	Primary Care Pediatrician and General Practitioner	• Management of mild AD, • Promotion of basic management strategies of AD (i.e. moisturizing, mild-moderate potency topical steroids, antibiotics) • Refer moderate-severe AD patients to specialists
Phase 2	Community or 1-2^nd levels Hospitals	Pediatric Allergist and/or Dermatologist	• Management of mild to moderate AD (SCORAD <50) using I-II line therapy (eg. Wet-wrap therapy; phototherapy) • Specific testing, if needed (eg. skin prick test and/or serum specific IgE testing, patch test, biopsy) • Educational therapy • To refer the patient to a University or 3^rd level Hospital if severe AD (SCORAD >50) or difficult to treat AD patient
Phase 3	University or 3^rd level Hospitals	Pediatric allergist AND dermatologist	• Re-evaluation of differential diagnosis and comorbidities • Definition of the baseline severity (SCORAD and EASI) and further specific testing, if needed • To start III line therapies for severe AD (eg. add on immunosuppressants, biologics) and management of eventual comorbidities • Involvement of other specialist health care professionals (eg. immunologist, psychologist, dietician)

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