Recognizing secondary infection in patients with atopic dermatitis: Head & neck atopic dermatitis

Atopic dermatitis is a hereditary chronic skin disease characterized by severe itching, recurrent course and association with other diseases of atopic nature, as well as numerous complications, which include the addition of a secondary infection. Head and neck atopic dermatitis (HNAD) is a special phenotype of atopic dermatitis that occurs in adolescents and adults. A characteristic feature of HNAD is the lesion of skin areas rich in sebaceous glands (face, neck, upper third of the chest and back), which is associated with the active participation of Malassezia fungi in the pathogenesis of the dermatosis. The multifactorial pathogenesis of HNAD, often persistent course, the impossibility of complete elimination of the provoking factor, as well as the addition of a secondary bacterial infection against the background of itching, necessitate a comprehensive approach to the treatment of this condition and the use of combination drugs containing a glucocorticosteroid, an antimycotic and an antibiotic to relieve exacerbations. The article examines the etiology, mechanisms of development of HNAD, clinical features, as well as modern methods of therapy, the practical application of which is demonstrated in a clinical example: patient, 19 years old, complaining of itchy, flaky rashes in the face and neck area, existing for 3 weeks. Based on the clinical picture, a diagnosis was made: atopic dermatitis of the face and neck. Given the multifaceted cause of the condition, namely the participation of both a pronounced immune response characteristic of AD, active colonization by Malassezia fungi, as well as open “gates” for secondary bacterial infection in the form of erosions, the prescription of a topical glucocorticosteroid was pathogenetically justified.