Current Challenges in Atopic Dermatitis: An Italian Delphi Consensus with a Special Focus on Moderate Disease

Introduction: Atopic dermatitis (AD) is a chronic, inflammatory skin disease clinically characterized by eczematous lesions and severe itch, significantly affecting the patients' quality of life. AD is classified as mild, moderate, or severe according to the extent and severity of these lesions. While therapeutic protocols for mild and severe AD are well-defined, the moderate stage represents a clinical 'gray zone' characterized by inconsistent management. It is frequently mismanaged, oscillating between undertreatment and the indiscriminate use of traditional systemic therapies. The moderate stage of AD requires a tailored approach to maximize topical treatments efficacy, avoid the side effects of systemic drugs, while remaining ready to escalate therapy if needed. Methods: An Italy-based, expert-Delphi consensus was used to: (1) reach a consensus on moderate AD classification criteria; (2) characterize the disease-specific burden in these patients; (3) identify key elements and concerns in moderate AD treatment; and (4) identify the therapeutic and management-related unmet needs of this subset of patients. Results: Agreement was reached for 26 final statements, which included highlighting a significant disease burden also for patients with moderate AD. Conclusions: The findings underscore a misalignment between the actual disease burden of moderate AD and current regulatory reimbursement criteria. In Italy, the restricted access to innovative systemic therapies for this specific patient population represents a critical healthcare gap.