Antibodies | Systemic Treatment Strategies for Head and Neck Atopic Dermatitis

This article systematically summarizes the pathogenesis, clinical challenges, and efficacy and safety of various systemic treatment strategies for Head and Neck Atopic Dermatitis (HND), with a particular focus on the use of biologics and JAK inhibitors, providing personalized treatment strategies for refractory HND.

 

Literature Overview

This article, titled 'Head and Neck Dermatitis in Atopic Dermatitis: A Narrative Review of Pathogenesis, Clinical Challenges, and Therapeutic Strategies,' published in the journal Antibodies, reviews and summarizes the pathogenesis, clinical features, and systemic treatment strategies of head and neck atopic dermatitis (HND). The article focuses on analyzing the efficacy and adverse reactions of different biologics, such as dupilumab, tralokinumab, lebrikizumab, and JAK inhibitors in HND, aiming to provide evidence for clinical treatment.

Background Knowledge

Atopic dermatitis (AD) is a chronic recurrent inflammatory skin disease affecting up to 20% of children and 10% of adults globally. HND is a special phenotypic form of AD that mainly affects the head and neck area, with clinical manifestations and treatment responses distinct from other regions. This may be related to local allergen exposure, skin barrier dysfunction, changes in Malassezia flora, and the regional immune microenvironment. HND accounts for 36% of adult AD cases and up to 79% in children, predominantly involving the face and neck area. It is often associated with more severe skin lesions and greater quality of life burden. Although biologics such as dupilumab, tralokinumab, and lebrikizumab have shown good efficacy in AD, HND patients often experience delayed treatment response or adverse reactions such as facial redness (FR). Moreover, JAK inhibitors have demonstrated rapid and significant efficacy in refractory HND, especially for dupilumab-related FR. This article reviews the pathogenesis of HND and evaluates clinical evidence of current systemic treatment strategies, offering references for personalized treatment.

 

 

Research Methods and Experiments

This study employed a narrative literature review approach to search for systemic treatment studies on HND published between January 2018 and June 2025 in the PubMed, Embase, Medline, Web of Science, and Scopus databases. Inclusion criteria comprised original research articles, clinical trials, systematic reviews, or meta-analyses focusing on treatment responses in the head and neck area among patients with moderate to severe AD. The study analyzed efficacy outcomes (e.g., EASI-H&N score, erythema score, patient-reported outcomes) and adverse events (e.g., facial redness, psoriasiform reactions) of various systemic treatments (dupilumab, tralokinumab, lebrikizumab, and JAK inhibitors) for HND. Additionally, the impact of different mechanisms (e.g., IL-4/IL-13, IL-13-specific, JAK-STAT) on HND was assessed.

Key Conclusions and Perspectives

• Dupilumab consistently demonstrates significant efficacy for HND in both clinical trials and real-world studies, though response rates are lower compared to other body regions. Approximately 4%-43.8% of patients develop facial redness (FR), prompting treatment discontinuation or switching to JAK inhibitors in some cases.
• Tralokinumab and lebrikizumab both exhibit favorable efficacy in HND with lower rates of facial redness, particularly effective in IL-22-driven phenotypes.
• JAK inhibitors, especially upadacitinib, show rapid and significant improvement in refractory HND or dupilumab-associated FR, making them suitable alternatives when biologics fail or exhibit heterogeneous responses.
• The article emphasizes the need for personalized systemic treatment selection based on patient response and tolerability to balance efficacy and adverse effects.

Research Significance and Prospects

This review provides a comprehensive summary of current treatment strategies for head and neck atopic dermatitis, highlighting regional response differences. Future research should further explore the immune heterogeneity of HND, identify biomarkers predictive of treatment response, and assess the long-term safety of JAK inhibitors. Additionally, combination therapies targeting Malassezia-associated immune responses may represent a promising new direction.

 

 

Conclusion

Head and neck atopic dermatitis (HND) presents a significant clinical challenge, often exhibiting suboptimal responses to biologics or developing adverse effects such as facial redness. This article systematically reviews multiple systemic treatment strategies, including IL-4Rα, IL-13-specific, and JAK inhibitors, evaluating their efficacy and safety profiles in HND. The study highlights that while dupilumab remains effective in treating HND, some patients develop facial redness or diminished responses. Tralokinumab and lebrikizumab show superior outcomes in managing redness and facial dermatitis. JAK inhibitors demonstrate significant efficacy in refractory HND cases or those with dupilumab-related adverse effects, underscoring their potential in personalized treatment. In conclusion, systemic treatment should be individualized based on patient characteristics and treatment responses to optimize HND management.

 

Giuseppe Lauletta, Cataldo Patruno, Claudio Brescia, Emanuela Martina, and Maddalena Napolitano. Head and Neck Dermatitis in Atopic Dermatitis: A Narrative Review of Pathogenesis, Clinical Challenges, and Therapeutic Strategies. Antibodies.