Head and Neck Atopic Dermatitis: Which Systemic Treatments Work Best?

Original Article : Effectiveness of Systemic Treatments for Atopic Dermatitis in the Head-and-Neck-Area: A Systematic Review and Meta-analysis

What are the key takeaways of this article?

Atopic dermatitis (AD) involving the head and neck (H&N) is a common and particularly burdensome presentation of disease, often associated with reduced quality of life, visible skin changes, and treatment challenges due to the sensitivity of the area. Although systemic therapies are increasingly used for moderate-to-severe AD, their effectiveness specifically in the H&N region has not been well characterized. A systematic review and meta-analysis by Steven et al. evaluated the performance of currently approved systemic anti-inflammatory therapies in this anatomically-sensitive region. 

Following a PRISMA-guided systematic search, studies reporting treatment responses in the H&N region were identified using PubMed, EMBASE, and Web of Science from database inception through June 2025. The main outcomes assessed were mean percentage change in EASI-HN (Eczema Area and Severity Index for the head-and-neck region) and the proportion of patients achieving EASI75-HN, or 75% improvement in disease severity in the H&N area. In total, 22 publications representing 32 unique studies and 11,372 patients were included. These studies comprised both post hoc analyses of randomized controlled trials and real-world observational studies, allowing assessment across a broad range of treatment settings. 

Interestingly, their findings suggest that biologics and Janus kinase inhibitors (JAK inhibitors) are effective for treating AD in the H&N region, with outcomes that appear comparable to treatment responses seen in other body regions. At approximately 16 weeks, mean reductions in EASI-HN ranged from 59% with dupilumab 300 mg every 2 weeks without topical therapy and 67% with lebrikizumab 250 mg every 2 weeks without topical therapy. Greater reductions were observed, up to 80% with upadacitinib 30 mg daily and 85% with dupilumab used alongside concomitant topical therapy. The proportion of patients achieving EASI75-HN ranged from 20% with baricitinib to 66% with upadacitinib 30 mg daily, suggesting meaningful clinical improvement with several advanced systemic options. 

Importantly, the review also highlights some nuances in treatment response. Historically, the H&N region has been considered more difficult to treat, and certain patients may experience persistent or paradoxical facial dermatitis despite systemic therapy. However, the literature from this review suggests that newer targeted systemic therapies can still provide substantial improvement in this specific region. Evidence using cyclosporine and methotrexate, which are more conventional systemic agents, was comparatively limited and less readily comparable to the newer agents. Thus, this emphasizes the need for more robust region-specific data for traditional therapies. 

Together, these results support the use of modern systemic therapies for patients with H&N-involved atopic dermatitis, an especially impactful phenotype due to its visibility and psychosocial burden. Stevens et al. conclude that biologics and JAK inhibitors are effective options for this difficult-to-treat area, but note that direct comparisons between conventional therapies remain lacking. Therefore, future studies focused specifically on regional disease patterns, including H&N dermatitis, may help better individualize therapy selection and improve care for patients with AD involving high-impact visible areas. 

Publication Date: May 29, 2026

Reference:

Stevens EM, Vester-Glowinski K, Skov L, Gyldenløve M, Loft N, et al. Effectiveness of Systemic Treatments for Atopic Dermatitis in the Head-and-Neck-Area: A Systematic Review and Meta-analysis. American Journal of Clinical Dermatology. 2026

Summary By: Megan Lowe