Head and Neck Dermatitis, A Subtype of Atopic Dermatitis Induced by Malassezia Spp | PracticeUpdate



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• This study determined the characteristics and treatment responses in head and neck dermatitis (HND). When 31 patients were categorized into "adolescent-onset" (n=17) or "adult-onset" (n=14), 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 (P < .05), 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 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.

– InYoung Kim, MD, PhD

Abstract 

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 (P < .05). Adult-onset HND was associated with concomitant widespread atopic eczema, involving the flexural areas of the upper and lower limbs, trunk, nipples, or hands (P < .05). 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.

Pediatric Dermatology

Head and Neck Dermatitis, A Subtype of Atopic Dermatitis Induced by Malassezia Spp: Clinical Aspects and Treatment Outcomes in Adolescent and Adult Patients

Pediatr Dermatol 2020 Nov 06;[EPub Ahead of Print], A Guglielmo, A Sechi, A Patrizi, C Gurioli, I Neri 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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