Prevention and Management of Pediatric Sensitive Skin Conditions in India: A Modified Delphi Consensus

Sensitive skin poses significant dermatological challenges in the pediatric population, necessitating thorough exploration and understanding. In this study, we aim to provide neonatologists, pediatricians, dermatologists, and allergists in India with consensus-based recommendations for the prevention and management of sensitive skin in the pediatric age group. A modified Delphi method was used to arrive at a consensus. A group of 15 experts with experience in pediatric skincare constituted the panel. Panel members representing diverse specialties from the major regions of India participated in the consensus process. Statements were developed based on a structured review of the literature identified through PubMed/Medical Literature Analysis and Retrieval System Online (MEDLINE) (January 2000 to May 2024; updated in March 2025) using the keywords "sensitive skin," "pediatric," "emollient," "prevention," and other related terms. Ninety-six clinically relevant questions and/or statements were drafted for discussion: (i) burden, pathophysiology, and challenges in the diagnosis of sensitive skin; (ii) symptoms, risk factors, and consequences; (iii) clinical diagnosis; (iv) prevention and management; and (v) the positioning of colloidal oatmeal-based emollients in managing and preventing sensitive skin in the pediatric population. The consensus level was classified into agreement (mean score of ≥4), no consensus, and exclusion (mean score of <4 after the second round). The process involved two rounds of Delphi surveys and one round of discussion. The experts unanimously agreed that diaper dermatitis, xerosis, and atopic dermatitis (AD) were the most prevalent sensitive skin conditions in children. Physical examinations and assessments of clinical and medical histories were the most effective primary diagnostic methods for identifying sensitive skin. The experts recommended moisturizers/emollients as a cornerstone for managing sensitive skin conditions and enhancing skin health and quality of life (QoL). Emollients should hydrate the skin, repair the skin barrier, and restore ceramide and microbiome balance, all while avoiding irritants. The experts recommended colloidal oatmeal-based emollients in xerosis and AD and as supportive adjunctive care alongside allergen avoidance in allergic contact dermatitis because of their prebiotic properties, soothing effects, and ability to activate endogenous ceramide production, which helps restore the skin's barrier and integrity. In the panel's view, the early and long-term usage of colloidal oatmeal-based emollients helps in the reduction of flare severity and frequency and, potentially, reliance on corticosteroids.