{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T15:53:22Z","timestamp":1792857202079,"version":"4.5.0"},"reference-count":75,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T00:00:00Z","timestamp":1764892800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibodies"],"abstract":"<jats:p>Background: Head and neck dermatitis (HND) represents a challenging phenotype of atopic dermatitis (AD), often showing suboptimal response or paradoxical worsening during biologic therapy. Objective: To review the efficacy and safety of current systemic treatments for HND, with a focus on dupilumab, tralokinumab, lebrikizumab, and janus kinase (JAK) inhibitors. Methods: We conducted a narrative review of randomized controlled trials, post hoc analyses, and real-world studies assessing clinical outcomes in patients with moderate-to-severe AD involving the head and neck. Outcomes included Eczema Area and Severity Index (EASI) H&amp;N subscore, erythema grade, patient-reported measures, and adverse events. Results: Dupilumab shows substantial efficacy for HND in both clinical trials and real-life studies; however, responses are often less pronounced than in other anatomical regions, and facial redness (FR) has emerged as a notable adverse event in up to 9% of patients. Tralokinumab and lebrikizumab demonstrate significant improvements in HND involvement, with low incidence of paradoxical reactions. JAK inhibitors, particularly upadacitinib, provide rapid and marked improvement in refractory cases and in patients developing FR during biologic therapy. Conclusions: Systemic therapy for HND should be individualized, balancing efficacy and tolerability. JAK inhibitors represent a valuable alternative in biologic-refractory phenotypes or in patients experiencing dupilumab-associated FR.<\/jats:p>","DOI":"10.3390\/antib14040104","type":"journal-article","created":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T10:50:38Z","timestamp":1764931838000},"page":"104","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Head and Neck Dermatitis in Atopic Dermatitis: A Narrative Review of Pathogenesis, Clinical Challenges, and Therapeutic Strategies"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-5607-8877","authenticated-orcid":false,"given":"Giuseppe","family":"Lauletta","sequence":"first","affiliation":[{"name":"Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80128 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8661-2822","authenticated-orcid":false,"given":"Cataldo","family":"Patruno","sequence":"additional","affiliation":[{"name":"Department of Medicine and Health Sciences \u201cVincenzo Tiberio\u201d, University of Molise, 86100 Campobasso, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-5094-5052","authenticated-orcid":false,"given":"Claudio","family":"Brescia","sequence":"additional","affiliation":[{"name":"Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80128 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Cosenza","sequence":"additional","affiliation":[{"name":"Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80128 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina","family":"D\u2019Elia","sequence":"additional","affiliation":[{"name":"Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80128 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Ventura","sequence":"additional","affiliation":[{"name":"Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80128 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuela","family":"Martina","sequence":"additional","affiliation":[{"name":"Dermatology Clinic, Department of Clinical and Molecular Sciences, Polytechnic Marche University, 60121 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3309-8190","authenticated-orcid":false,"given":"Maddalena","family":"Napolitano","sequence":"additional","affiliation":[{"name":"Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, 80128 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/S0140-6736(20)31286-1","article-title":"Atopic dermatitis","volume":"396","author":"Langan","year":"2020","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1093\/bjd\/ljad286","article-title":"The future is now: The Global Atopic Dermatitis Atlas (GADA)","volume":"189","author":"Arents","year":"2023","journal-title":"Br. 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