Neck eczema
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Neck Eczema: Insights from Recent Research
Epidemiology and Prevalence of Neck Eczema
Neck eczema is a common manifestation of eczema, affecting a significant portion of patients with head and neck eczema. In a study involving 3,684 patients with eczema, 15% presented with head and/or neck eczema. Specifically, 4% of these cases were localized to the neck . This highlights the prevalence of neck eczema among individuals with broader head and neck eczema conditions.
Clinical Characteristics and Patterns
Contact Dermatitis and Neck Eczema
Contact dermatitis is a prevalent form of neck eczema. In a study, 76% of patients with neck eczema were diagnosed with contact dermatitis, which was more common than endogenous or unclassifiable eczema . This suggests that external irritants or allergens play a significant role in the development of neck eczema.
Paradoxical Erythema with Dupilumab Treatment
Patients with atopic dermatitis (AD) treated with dupilumab, a biologic therapy, have reported paradoxical erythema in the head and neck area. This erythema appears sharply demarcated and patchy, differing from typical eczema presentations. Despite this reaction, most patients continued dupilumab treatment due to its overall effectiveness in managing AD .
Allergic Contact Dermatitis from Cosmetic Products
Allergic contact dermatitis can also be triggered by cosmetic products. For instance, a case study reported a woman developing head and neck eczema due to a shampoo containing propolis. This highlights the importance of identifying and avoiding potential allergens in personal care products .
Unique Presentations and Complications
Indurated Erythema and Systemic Symptoms
In some cases, neck eczema can present with indurated erythema and systemic symptoms such as lymphadenopathy and leukocytosis. This was observed in a 62-year-old patient with progressive eczematous rashes on the neck and upper back, accompanied by fatigue and night sweats . Such presentations may require comprehensive medical evaluation to rule out underlying systemic conditions.
Dirty Neck Syndrome
Dirty Neck (DN) syndrome is characterized by reticulate hyperpigmentation of the neck, often seen in patients with severe atopic dermatitis. DN can be confluent or reticulate and is typically resistant to conventional treatments. However, recent reports suggest that dupilumab may be effective in managing DN, providing significant improvement in skin appearance and patient quality of life 510.
Management and Treatment
Challenges in Treatment
Treating neck eczema can be challenging, especially when it is resistant to standard therapies. For example, a patient with allergic contact dermatitis did not respond to topical steroids or systemic treatments until the allergen (shampoo) was identified and discontinued . Similarly, DN often requires advanced treatments like dupilumab for effective management .
Dupilumab for Severe Cases
Dupilumab has shown promise in treating severe atopic dermatitis, including cases with neck involvement. Despite some patients developing paradoxical erythema, the overall satisfaction with dupilumab remains high due to its efficacy in reducing eczema symptoms 210.
Conclusion
Neck eczema is a multifaceted condition with various triggers and presentations. Contact dermatitis is a common cause, often linked to external allergens. Advanced treatments like dupilumab offer hope for patients with severe or resistant forms of neck eczema, although they may come with unique side effects. Identifying and avoiding allergens, along with appropriate medical interventions, are key to managing this condition effectively.
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