European project on the competence in pediatric atopic dermatitis management in primary care: Pilot study in a Balkan region

Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disease that frequently begins in early childhood and imposes a substantial clinical and psychosocial burden on affected patients and their families. Given its high prevalence and the limited availability of pediatric dermatology services across many European regions, general pediatricians play a pivotal role in diagnosis, severity assessment, and initial management. As part of an EPA-UNEPSA initiative to evaluate and enhance pediatric competence in AD care across Europe, this pilot study assessed knowledge, attitudes, and management practices among general pediatricians in Serbia. In April 2025, an anonymous, web-based, 19-item questionnaire developed by EPA-UNEPSA experts was distributed to primary care pediatricians; 14% of all national pediatricians completed the survey. The questionnaire explored understanding of AD pathophysiology, use of standardized scoring systems, therapeutic decision-making, complementary therapy use, allergy workup, prevention strategies, and referral thresholds. Results indicate strong theoretical knowledge, with near-universal recognition of the multifactorial nature of AD (100%) and awareness of objective severity tools such as SCORAD (96.8%). Most respondents (93.7%) believe primary care physicians should diagnose and treat AD; however, only around half feel capable of managing more than 45% of cases, revealing a substantial “competency gap.” Pediatricians report structured use of complementary therapies, widespread reliance on nutraceuticals, in particular a combined Omega-3, GLA, and Vitamin D nutraceutical formulation (61,80%), and high acceptance of microbiota-targeted approaches. Ambiguity persists regarding prevention with neonatal emollients and perceived prevalence of food allergies. These findings highlight the need for targeted educational programs to strengthen longitudinal management capacity and support harmonized, evidence-based AD care across Europe. Finally, the importance to expanding this project to other European countries in order to validate the results of this pilot study and to compare the degree of the divergences across diverse healthcare systems.