Eczema on neck
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Eczema on the Neck: Causes, Symptoms, and Treatments
Epidemiology of Neck Eczema
Eczema, a common inflammatory skin condition, can affect various parts of the body, including the neck. In a study involving 3,684 patients with eczema, 21 individuals (4%) had eczema localized to the neck1. This highlights that while neck eczema is not the most common form, it is a significant concern for a subset of patients.
Causes of Neck Eczema
Contact Dermatitis
One of the primary causes of neck eczema is contact dermatitis, which can be allergic or irritant in nature. In the study mentioned above, contact dermatitis was prevalent in 76% of the neck eczema cases1. Allergic contact dermatitis can be triggered by various substances, including cosmetics and personal care products. For instance, a case study reported a 42-year-old woman who developed head and neck eczema due to an allergic reaction to propolis in a shampoo2.
Atopic Dermatitis
Atopic dermatitis (AD) is another common cause of neck eczema. AD is a chronic condition characterized by itchy and inflamed skin. It can affect any part of the body, including the neck, and is often associated with other allergic conditions like asthma and allergic rhinitis9. In some cases, AD can lead to a specific type of neck eczema known as "Dirty Neck," characterized by reticulate hyperpigmentation6 8.
Drug-Induced Reactions
Certain medications can also induce eczema-like reactions on the neck. For example, patients treated with dupilumab, a biologic for atopic dermatitis, have reported paradoxical erythema in the head and neck area4. This reaction is characterized by sharply demarcated, patchy erythema that differs from typical eczema.
Symptoms of Neck Eczema
The symptoms of neck eczema can vary depending on the underlying cause but generally include:
- Itching and Redness: Common in both contact dermatitis and atopic dermatitis1 9.
- Erythematous and Edematous Papules: Often seen in allergic contact dermatitis2.
- Hyperpigmentation: Notably seen in "Dirty Neck" associated with atopic dermatitis6 8.
- Indurated, Erythematous Plaques: Can occur in severe cases, sometimes associated with systemic symptoms like fatigue and night sweats3.
Treatment Options
Topical Treatments
Topical corticosteroids and calcineurin inhibitors are commonly used to manage eczema symptoms. However, their effectiveness can vary. For instance, "Dirty Neck" often shows limited response to these treatments8.
Systemic Treatments
For more severe cases, systemic treatments like oral corticosteroids or biologics such as dupilumab may be prescribed. Dupilumab has shown significant efficacy in treating severe atopic dermatitis, including cases with neck involvement8 9. However, it can also cause paradoxical reactions, as mentioned earlier4.
Avoidance of Triggers
Identifying and avoiding triggers is crucial in managing contact dermatitis. This may involve discontinuing the use of certain cosmetics or personal care products, as illustrated in the case of the woman allergic to propolis in her shampoo2.
Conclusion
Neck eczema is a multifaceted condition with various underlying causes, including contact dermatitis, atopic dermatitis, and drug-induced reactions. Effective management requires a comprehensive approach that includes topical and systemic treatments, as well as avoidance of known triggers. Understanding the specific characteristics and triggers of neck eczema can significantly improve patient outcomes.
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Most relevant research papers on this topic
Eczema of the Face, Scalp and Neck: An Epidemiological Comparison by Site
Eczema of the face, scalp, and neck is more common in females, with contact dermatitis being more prevalent in ear and neck eczema, and endogenous/unclassifiable eczema in lip and scalp eczema.
Observational StudyAllergic contact dermatitis of head and neck by propolis contained in a shampoo
Propolis in Propomel shampoo may cause allergic contact dermatitis of the head and neck, with the shampoo causing intense pruritus and eczema.
Case ReportIndurated erythema of the neck and upper back
Indurated erythema of the neck and upper back is a common presentation in patients with lymphadenopathy and leukocytosis, but may not be a primary diagnosis.
Case ReportClinical and histopathological characterization of paradoxical head and neck erythema in patients with atopic dermatitis treated with dupilumab: a case series
Dupilumab treatment for atopic dermatitis can cause paradoxical head and neck erythema in some patients, suggesting a drug-induced skin reaction.
Case Report
Rigorous Journal
Highly CitedEczema herpeticum in a wrestler.
Eczema herpeticum is a rapidly spreading skin infection that can be exacerbated by herpes simplex virus and atopic dermatitis, requiring early antiviral treatment.
The ‘Dirty Neck’—a reticulate pigmentation in atopics
The 'Dirty Neck' is a reticulate pigmentation in atopic eczema patients, with two distinct patterns: mild in young patients with seasonal pigmentation and severe after puberty.
“Eczema Autolytica”
Autolytic eczema is a secondary, non-infectious skin condition that occurs after a primary eruption of dermatitis or ulceration, often in the leg or ankle region, and often spreads to covered areas.
A case of dirty neck in severe and diffuse atopic dermatitis successfully treated with dupilumab
Dupilumab effectively treats dirty neck in adults with severe atopic dermatitis, improving skin quality and reducing embarrassment.
Case ReportEffectiveness of dupilumab treatment in 95 patients with atopic dermatitis: daily practice data
Dupilumab treatment effectively reduced itching and inflammation in 95 patients with atopic dermatitis, improving their quality of life.
Rigorous JournalAtopic Dirty Neck or Acquired Atopic Hyperpigmentation? An Epidemiological and Clinical Study from the National Skin Centre in Singapore
Acquired atopic hyperpigmentation is highly prevalent in adolescent Asian males with atopic dermatitis, and optimal control of eczema may improve and potentially prevent its development.
Observational Study