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Fungal Head and Neck Dermatitis: Current Understanding and Management.

Albert C Chong1,2, Francisco José Navarro-Triviño3, Malcolm Su4

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Summary
This summary is machine-generated.

Head and neck dermatitis (HND), a severe form of atopic dermatitis (AD), is linked to fungal Malassezia. Antifungal treatments show promise for HND, but long-term efficacy and safety require further investigation.

Keywords:
MalasseziaAtopic dermatitisDupilumab-associated head and neck dermatitisFungiHead and neck dermatitisTh17

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Area of Science:

  • Dermatology
  • Immunology
  • Microbiology

Background:

  • Head and neck dermatitis (HND) is a debilitating form of atopic dermatitis (AD) impacting quality of life.
  • HND presents treatment challenges due to topical therapy limitations and potential dupilumab-induced HND (DAHND).
  • Fungi, especially Malassezia spp., are implicated in HND pathogenesis, triggering immune responses via Th17/Th2 pathways.

Purpose of the Study:

  • To review the role of fungi, particularly Malassezia, in HND development and treatment.
  • To evaluate the efficacy and limitations of current and emerging therapies for HND.
  • To explore the influence of mycobiome on HND severity and potential precision medicine approaches.

Main Methods:

  • Review of current evidence, including double-blind, placebo-controlled trials on antifungal efficacy.
  • Analysis of pathogenesis involving fungal antigens, skin barrier defects, and immune activation.
  • Examination of treatment outcomes for antifungals, Janus kinase inhibitors, and other emerging therapies.

Main Results:

  • Malassezia sensitization may differentiate HND from other AD types.
  • Antifungal treatments demonstrate benefits in HND, though sustained symptom relief is unclear.
  • Oral antifungals are more effective but carry long-term risks; DAHND may also be fungal-mediated.
  • Janus kinase inhibitors are effective but have potential side effects; OX40/OX40L inhibitors and tralokinumab are promising.

Conclusions:

  • Fungal infections, particularly Malassezia, play a significant role in head and neck dermatitis.
  • Antifungal therapies offer a potential treatment avenue, but long-term efficacy and safety need further study.
  • Understanding the mycobiome is crucial for developing personalized treatment strategies for HND.