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Atopic dirty neck or acquired atopic hyperpigmentation? An epidemiological and clinical study from the National Skin
Amélie C Seghers1, Joyce S S Lee, Chuen Seng Tan
1Department of Dermatology, National Skin Centre, Singapore, Singapore.
Background:
'Atopic dirty neck' is a poorly understood acquired hyperpigmentation in patients with atopic dermatitis (AD).
Objective:
To report a single-centre experience with synthesis of this entity's features.
Methods:
All patients with AD with dirty neck seen over a 5-month period at the National Skin Centre were invited to participate.
Results:
Out of 544 AD patients examined, 78 (14.3%) had acquired pigmentation of the neck. The majority had moderate-to-severe underlying eczema. Histopathology showed increased epidermal melanin and dermal melanophages, a thickened basement membrane and a dense superficial perivascular infiltrate.
Conclusion:
Acquired atopic hyperpigmentation has a high prevalence, particularly in adolescent Asian males. Clinico-pathological correlation suggests it results from both frictional melanosis and post-inflammatory hyperpigmentation. The rippled appearance and the onset in adolescence are probably due to accentuation of the juxta-clavicular beaded lines. Optimal control of eczema may improve and potentially prevent the development, which is of importance considering the psychosocial impact of the condition.