Atopic head and neck dermatitis

Differential diagnosis
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Malassezia-associated head-and-neck dermatitis: This is likely not a manifestation of increased Malassezia fungal colonization, but rather of a disrupted barrier–lipid–mycobiome–immune axis. Dupilumab eliminates IL-4/IL-13-dominant inflammation but may reveal a persistent or relatively prominent Th17, Th1, or autoallergenic reaction in the head and neck region. Therefore, dupilumab can highly effectively improve generalized atopic dermatitis while simultaneously revealing localized Malassezia-associated “head and neck dermatitis.”

Seborrheic dermatitis: Yellowish, greasy scales on the scalp, eyebrows, and nasolabial folds; usually less pronounced atopic lichenification

Allergic contact dermatitis: Distribution dependent on exposure; positive patch test

Irritant contact dermatitis: Burning sensation often more pronounced than itching; associated with cleaning, cosmetics, or masks.

Airborne contact dermatitis: Affects exposed areas of the face and neck; deep skin folds are often spared (seasonal association?)

Rosacea: Central facial, fluctuating erythema, telangiectasias, follicular papules and pustules; no typical eczematous scaling.

Perioral dermatitis: Monomorphic papules around the mouth, eyes, or nose; a narrow, clear border around the vermilion border of the lips.

Psoriasis/seborrheic psoriasis: Sharper borders extending beyond the hairline, more pronounced scaling, other signs of psoriasis

Tinea: Plaques with distinct borders that spread centrifugally and are itchy; identification of the causative agent

Photodermatosis: Light-dependent distribution with exclusion of shaded areas. Seasonal exacerbation

Dermatomyositis or systemic lupus erythematosus: Severe malaise, extensive redness and swelling in sun-exposed skin areas, additional cutaneous or systemic signs.

Cutaneous T-cell lymphoma: Persistent, progressive lesions, some of which are infiltrated or have an unusual configuration

Topical steroid withdrawal reaction (steroid withdrawal syndrome): Burning, confluent erythema following prolonged or local application of highly potent glucocorticoids