Head and Neck Dermatitis, A Subtype of Atopic Dermatitis: Treatment outcomes in adolescent and adult patients
Pediatric Dermatology:
Head and neck dermatitis (HND) is a clinical variant of
atopic dermatitis (AD), presenting in adolescence or adulthood and
characterized by involvement of the head, neck, and superior part of the trunk.
The role of Malassezia spp has been advocated in the
pathogenesis of HND, and antifungal agents represent the treatment of
choice.
TAKE-HOME MESSAGE
This study determined the characteristics and treatment
responses in head and neck dermatitis (HND). 31 patients were categorized into
“adolescent-onset” or “adult-onset”, it was evident that the two groups
differed in clinical presentation.
The adolescent-onset group was significantly more likely to
have a history of childhood atopic dermatitis (AD) and exclusively involve the
head and neck areas, whereas the adult-onset group was significantly more
likely to have concomitant diffuse dermatitis, in addition to the head and
neck.
Both groups responded well to a combination of Topical Steroids or Calcineurin inhibitors (pimecrolimus and tacrolimus topical) and Oral Itraconazole (100 mg daily for 1 month, then 100 mg once weekly for another month).
Head and neck dermatitis is a peculiar form of AD, which is
thought to be driven at least in part by immune responses against Malassezia spp
facilitated by the disrupted skin barrier.
These findings suggest that there may be two clinical
phenotypes based on time at onset. The adolescent-onset form correlated with
childhood AD and predominant localization to head and neck, whereas the
adult-onset form presented more with concomitant widespread eczema and less
frequent childhood AD history.
Treatment of both
cohorts was effective with a combination of oral itraconazole and topical
corticosteroids or calcineurin inhibitors.
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BACKGROUND AND
OBJECTIVES
Head and neck dermatitis (HND) is a clinical variant of
atopic dermatitis (AD), presenting in adolescence or adulthood and
characterized by involvement of the head, neck, and superior part of the trunk.
The role of Malassezia spp has been advocated in the pathogenesis of HND, and
antifungal agents represent the treatment of choice.
METHODS
A retrospective single-center study was performed to define
the clinical features and treatment response of HND among adolescent and adult
patients.
RESULTS
Thirty-one patients were identified, 17 with
"adolescent-onset" and 14 with "adult-onset" HND.
Adolescent-onset HND positively correlated with a past history of AD and
presented with exclusive head and neck involvement. Adult-onset HND was
associated with concomitant widespread atopic eczema, involving the flexural
areas of the upper and lower limbs, trunk, nipples, or hands. A positive
response to itraconazole in combination with topical treatments was observed in
both groups.
CONCLUSIONS
This study delineates two HND clinical phenotypes: adolescent
vs adult onset. Different characteristics were observed in terms of
relationship to AD and eczema localization. A history of AD in childhood and
presentation with exclusive involvement of head and neck regions was observed predominantly
in the adolescent-onset form, while adult-onset HND often occurred in
association with diffuse dermatitis and a past history of AD was less frequent
than in the adolescent group. The study is limited by the single-center
retrospective nature, which may lead to diagnostic and selection biases, and
the small cohort of patients.
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