Russian Journal of AllergyRussian Journal of AllergyРоссийский Аллергологический Журнал1810-88302686-682XPublishing House ABV Press1703310.36691/RJA17033ReviewsНаучные обзорыReview ArticleHead and neck atopic dermatitis: current pathogenetic aspects and therapeutic approachesАтопический дерматит с преимущественным поражением области головы и шеи: современные патогенетические аспекты и терапевтические стратегииhttps://orcid.org/0000-0002-0081-09815423-8683IvanovRoman A.ИвановРоман Александрович
Russian Federation

Cand. Sci. (Medicine)

канд. мед. наук

isxiks@gmail.comhttps://orcid.org/0000-0003-2252-85705906-9724MurashkinNikolay N.МурашкинНиколай Николаевич
Russian Federation

Dr. Sci. (Medicine), Professor

д-р мед. наук, профессор

m_nn2001@mail.ruhttps://orcid.org/0000-0002-1650-652X3893-9946EreshkoOksana A.ЕрешкоОксана Александровна
Russian Federation

Cand. Sci. (Medicine)

канд. мед. наук

ksenya2005@inbox.ruhttps://orcid.org/0009-0003-5367-32685930-8344PavlovaEkaterina S.ПавловаЕкатерина Станиславовна
Russian Federation
kat-rin-ps@yandex.ruhttps://orcid.org/0000-0002-4107-46425162-7846EpishevRoman V.ЕпишевРоман Владимирович
Russian Federation

Cand. Sci. (Medicine)

канд. мед. наук

drepishev@gmail.comNational Medical Research Center of Children’s HealthНациональный медицинский исследовательский центр здоровья детейThe First Sechenov Moscow State Medical University (Sechenov University)Первый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский Университет)Central State Medical AcademyЦентральная государственная медицинская академия06082025101020252232873033006202501082025Copyright ©; 2025, ABV-pressCopyright ©; 2025, ИД "АБВ-пресс"2025ABV-pressИД "АБВ-пресс"https://creativecommons.org/licenses/by-nc-nd/4.0/https://rusalljournal.ru/raj/article/view/17033

Persistent rashes in the head and neck area in patients with atopic dermatitis, particularly those developing after the initiation of dupilumab therapy, represent a complex clinical challenge due to the poorly understood causes and mechanisms of development, as well as the lack of standardized therapeutic approaches. Given the localization in cosmetically and functionally important areas of the skin (face, periauricular region, neck, upper torso), this form of atopic dermatitis is associated with significant stigmatization and a decrease in the patient’s quality of life. The refractory course of atopic dermatitis involving the face and neck may represent a distinct subgroup of patients with additional pathophysiological determinants and unique features of immune dysregulation that require special consideration. This article presents current insights into the etiopathogenesis of this condition and management strategies, including a review of clinical cases from our own practice. The relevance of the issue is underscored by its high prevalence and the potential risk of discontinuing targeted therapy, emphasizing the need for timely identification and appropriate management to avoid unnecessary treatment interruption. To optimize care and develop a personalized patient management strategy, we have proposed a decision-making algorithm that addresses the key questions clinicians may encounter when managing this specific patient group.

Персистирующие высыпания в области головы и шеи у пациентов с атопическим дерматитом, нередко возникающие на фоне начала терапии дупилумабом, представляют собой сложную клиническую задачу вследствие недостаточно изученных причин и механизмов развития, а также отсутствия унифицированных подходов к терапии. С учетом локализации в косметически и функционально значимых зонах кожного покрова (лицо, заушная область, шея, верхняя часть туловища) данная форма атопического дерматита связана со значительной стигматизацией и снижением качества жизни пациента. Рефрактерный вариант течения атопического дерматита с поражением лица и шеи может в целом описывать отдельную подгруппу пациентов, имеющих дополнительные патофизиологические детерминанты и особенности дисрегуляции иммунного ответа, требующие особого внимания. Статья содержит современные сведения, касающиеся этиопатогенеза этого состояния и тактики ведения пациентов с разбором клинических случаев из собственной практики. Значимость проблемы обусловлена как ее высокой распространенностью, так и риском возможного прекращения таргетной терапии, что делает особенно важными своевременное распознавание и корректное лечение для предотвращения его нецелесообразной отмены. Для оптимизации этого процесса и разработки персонифицированной стратегии ведения пациентов нами сформирован алгоритм принятия решений, отвечающий на основные вопросы, возникающие у специалиста при встрече с данной группой пациентов.

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