Proposal of Phenotypic Patterns in Facial Atopic Dermatitis: A Single-Center Retrospective Analysis of 100 Cases

Atopic dermatitis (AD) is a chronic inflammatory skin disorder characterized by eczematous lesions and pruritus. Facial and neck involvement in AD can be challenging to differentiate from other facial dermatoses, such as allergic contact dermatitis, seborrheic dermatitis, rosacea, and drug-induced facial dermatitis, complicating treatment strategies.

This study aimed to investigate the distribution of facial involvement patterns in patients with AD and to explore the differential diagnosis, focusing on head and neck lesions.

A retrospective study was conducted on 100 patients diagnosed with AD at a single medical center. Facial and neck lesions were categorized into 5 distinct patterns-periorificial, centrofacial, diffuse, patch, and mixed-based on anatomical distribution. The study also evaluated the impact of dupilumab treatment on these patterns.

The most frequently affected anatomical regions were the frontal (68%), buccal (60%), and orbital (57%) areas. The most common facial involvement pattern was periorificial (28%), followed by diffuse (24%) and centrofacial (21%). The dupilumab-treated group showed a higher frequency of the diffuse pattern compared to other treatment groups. Additionally, periorbital hyperpigmentation, Dennie-Morgan folds, and cheilitis were common minor features.

The study identified distinct facial involvement patterns in AD, with centrofacial and periorificial patterns being the most prevalent. These findings underscore the importance of recognizing facial and neck involvement in AD for accurate diagnosis and personalized treatment. Further large-scale studies are needed to validate these results and explore the underlying mechanisms influencing facial involvement.