Head and neck atopic dermatitis: current pathogenetic aspects and therapeutic approaches

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Abstract

Persistent rashes in the head and neck area in patients with atopic dermatitis, particularly those developing after the initiation of dupilumab therapy, represent a complex clinical challenge due to the poorly understood causes and mechanisms of development, as well as the lack of standardized therapeutic approaches. Given the localization in cosmetically and functionally important areas of the skin (face, periauricular region, neck, upper torso), this form of atopic dermatitis is associated with significant stigmatization and a decrease in the patient’s quality of life. The refractory course of atopic dermatitis involving the face and neck may represent a distinct subgroup of patients with additional pathophysiological determinants and unique features of immune dysregulation that require special consideration. This article presents current insights into the etiopathogenesis of this condition and management strategies, including a review of clinical cases from our own practice. The relevance of the issue is underscored by its high prevalence and the potential risk of discontinuing targeted therapy, emphasizing the need for timely identification and appropriate management to avoid unnecessary treatment interruption. To optimize care and develop a personalized patient management strategy, we have proposed a decision-making algorithm that addresses the key questions clinicians may encounter when managing this specific patient group.

About the authors

Roman A. Ivanov

National Medical Research Center of Children’s Health

Author for correspondence.
Email: isxiks@gmail.com
ORCID iD: 0000-0002-0081-0981
SPIN-code: 5423-8683

Cand. Sci. (Medicine)

Russian Federation, Moscow

Nikolay N. Murashkin

National Medical Research Center of Children’s Health; The First Sechenov Moscow State Medical University (Sechenov University); Central State Medical Academy

Email: m_nn2001@mail.ru
ORCID iD: 0000-0003-2252-8570
SPIN-code: 5906-9724

Dr. Sci. (Medicine), Professor

Russian Federation, Moscow; Moscow; Moscow

Oksana A. Ereshko

National Medical Research Center of Children’s Health

Email: ksenya2005@inbox.ru
ORCID iD: 0000-0002-1650-652X
SPIN-code: 3893-9946

Cand. Sci. (Medicine)

Russian Federation, Moscow

Ekaterina S. Pavlova

National Medical Research Center of Children’s Health

Email: kat-rin-ps@yandex.ru
ORCID iD: 0009-0003-5367-3268
SPIN-code: 5930-8344
Russian Federation, Moscow

Roman V. Epishev

National Medical Research Center of Children’s Health

Email: drepishev@gmail.com
ORCID iD: 0000-0002-4107-4642
SPIN-code: 5162-7846

Cand. Sci. (Medicine)

Russian Federation, Moscow

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2. Fig. 1. Modern concepts of the head and neck atopic dermatitis development due to Malassezia spp. skin hypercolonization (adapted based on data from source [3] using the online tool BioRender). Note. IL — interleukin; Ig — immunoglobulin.

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3. Fig. 2. Decision-making algorithm for developing an individualized management strategy for patients with head and neck atopic dermatitis. Note. AZP — activated zinc pyrithione; tGCS — topical glucocorticosteroids, TCI — topical calcineurin inhibitors; AB — antibiotic; AM — antimycotic.

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4. Fig. 3. Resolution of head and neck atopic dermatitis following the use of cream and shampoo containing activated zinc pyrithione.

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5. Fig. 4. Regression of inflammatory lesions and lichenification in the head and neck area following adjusted therapy in a 14-year-old patient with atopic dermatitis and allergic rhinitis.

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6. Fig. 5. Resolution of paradoxical erythema of the head and neck associated with dupilumab, following a change in therapy to a Janus-kinase inhibitor and the use of topical activated zinc pyrithione in a 17-year-old patient.

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