Features of the Course of Atopic Dermatitis with Facial and Neck Lesions (head and Neck)

Dermatitis of head and neck, also known as “head-and-neck dermatitis” (HNAD), is one of the specific manifestations of atopic dermatitis (AD) in adolescents and young adults. The epidermal barrier dysfunction, skin pathological immune responses, a direct damaging effect of the malassezial flora through the synthesis of virulence factors and mediated by maintaining immune inflammatory responses, as well as the attachment of secondary bacterial flora caused by scratching form the basis of pathogenetic mechanisms of this condition. The properties that define the HNAD rash is a focus on the seborrheic areas (a face, front surface of the neck, décolleté on the chest), severe itching, prolonged course, exacerbation characterized by excessive sweating. It appears that fungi of the genus Malassezia can play a role in the development of the disease. While they are considered to be part of the normal skin microbiome, a significant increase in the severity of atopic dermatitis was observed in patients with Malassezial flora, which was the reason for the theories devoted to the role of Malassezia spp. as a trigger of the disease. Atopic dermatitis can also develop as a side effect of using targeted therapy with IL4/13 blockers, which is explained at the present day by a shift of the immune response towards a Th-17-mediated reaction. The combination of both infectious and immune-mediated lesions in HNAD determines the necessity of an integrated approach to the therapy, in particular the use of topical combination drugs as the first-line therapy. The topical glucocorticosteroid (TGCS) therapy is aimed at suppressing the immune reactions that are responsible for inflammation in the skin, antifungal therapy is required to suppress the activity of the malassesial flora, and, finally, a secondary bacterial infection requires the prescription of topical antibacterial drugs.