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

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.