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Face of Frustration:
Navigating the Complexities of Head and Neck Atopic Dermatitis
This interactive case study was organised and funded by Leo Pharma and is intended for healthcare professionals only.
Disclosure
Dermatology
These interactive case studies were developed with support from Tom Gurney, Senior Medical Writer, EMJ. London, UK.
These are hypothetical patient cases and outcomes may not be reflective of clinical studies or real-life circumstances. This includes reference to agents that may be used off-label or for unlicensed indications. The mention of these agents and their uses is intended solely for educational purposes and should not be considered an endorsement or recommendation for their use outside approved indications. Please always consult guidelines and local prescribing information in your country of practice, as information may vary.
Disclaimer
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Adtralza ▼ (tralokinumab) is indicated for the treatment of moderate-to-severe atopic dermatitis in adult and adolescent patients 12 years and older who are candidates for systemic therapy. The medicinal product mentioned in this interactive case study is subject to additional monitoring. This will allow quick identification of new safety information. Healthcare professionals are asked to report any suspected adverse reactions. Prescribing information can be found here: ukie-altralza-prescribing-information.pdf. For those HCPs outside of the UK, please refer to local prescribing information.
Reporting of Suspected Adverse Reactions Adverse events should be reported. Reporting forms and information can be found at: www.mhra.gov.uk/yellowcard or search for MHRA Yellow card in the Google Play or Apple App Store. Adverse events should also be reported to Drug Safety at LEO Pharma by calling +44 (0)1844 347333 or e-mail: medical-info.uk@leo-pharma.com
3/17
A patient arrives for a dermatology review. Referral notes detail that he has: a history of eczema since childhood allergic rhinitis no significant family history of atopic diseases He is an office worker, non-smoker, and occasionally consumes alcohol.
Case Presentation: 35-Year-Old Male
Allergic rhinitis
Itchy ears and buzzing sound
Red, itchy and watery eyes
Sneezing, congestion and runny nose
Itchy or sore throat, cough and postnatal drip
Eczema
4/17
Redness on the face and neck. Dry, scaly patches on the forehead and around the eyes, with occasional oozing and crusting. Increased sensitivity to certain skincare products.
Symptoms:
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The patient’s quality of life is affected beyond physical symptoms, click through to learn more.
How Do the Physical Symptoms Affect the Patient?
References
1. Chu AWL et al. Ann Allergy Asthma Immunol. 2024;132(3):274-312. 2. Chang YS, Chiang BL. J Allergy Clin Immunol. 2018;142(4):1033-40. 3. Vakharia PP et al. Ann Allergy Asthma Immunol. 2017;119(6):548-52.e3. 4. Ghio D et al. Br J Health Psychol. 2021;26(1):214-31.
Social isolation, anxiety and depression, all of which interfere with daily activities, such as work, exercise, and hobbies.3,4
Reduced productivity at work due to sleep disturbance.1,2
The presence of visible skin lesions, especially on the face and neck, lead to feelings of self-consciousness and embarrassment.1
6/17
Which of the following symptoms is commonly observed in patients with head and neck involvement in moderate-to-severe atopic dermatitis (AD)?
Hair loss with scarring
Redness, scaling, and lichenification on the face and neck
Painless skin nodules on the scalp
Vesicular rash limited to the forehead
A
B
C
D
Head and neck involvement in atopic dermatitis often presents with visible and persistent symptoms such as erythema (redness), lichenification (skin thickening), and scaling, which are particularly distressing for patient due to the visibility and sensitivity of these areas.¹ These manifestations not only impact quality of life, but may also be more challenging to treat due to a constant exposure of exogenous triggers such as allergens and irritants.¹
1. Chovatiya R et al. Am J Clin Dermatol. 2025;DOI:10.1007/s40257-025-00931-1.
7/17
BSA: 26% Erythematous patches on the forehead, cheeks, chest, back and neck Lichenification due to chronic scratching Presence of excoriations No signs of secondary infection
Examination Information
A single item, patient reported outcome of itch severity in adults with moderate-to-severe atopic dermatitis. Patients report the intensity of the worst itch in the previous 24-hour period. 0 being no itch, 10 being worst itch imaginable.
Disease scores:
1. Hanifin JM et al. Dermatitis. 2022;33(3):187-92. 2. Yosipovitch G et al. Br J Dermatol. 2019;181(4):761-9. BSA: body surface area; EASI: Eczema Area and Severity Index; NRS: Numerical Rating Scale; IGA: Investigator’s Global Assessment.
Itch Numerical Rating Scale (NRS)2
Eczema Area and Severity Index (EASI)1
A tool used to measure the extent and severity of atopic dermatitis . Divides the body into 4 regions (head/neck, upper extremities, trunk, and lower extremities).
Each region is scored from 0 (none) to 3 (severe). The final EASI score is calculated as the sum of the regional scores (0–72).
Investigator’s Global Assessment (IGA)1
A scale that provides a global clinical assessment of atopic dermatitis severity by investigator. Ranges from 0 (clear) to 4 (severe).
Clear
Severe
Body Surface Area (BSA)1
The percentage of a person's skin affected by the condition. Assesses the extent and severity of disease. Can help to guide treatment decisions.
Mild
Moderate
<10% BSA
10–29% BSA
30-100% BSA
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The patient had previously trialled a range of treatments for his AD:
AD: atopic dermatitis; OTC: over-the-counter; TCI: topical calcineurin inhibitors. H&N: head and neck
Examination Continued
OTC hydrocortisone Mometasone Clobetasol for flares on hands TCIs (tacrolimus 0.1% ointment)
High potency topical corticosteroids were avoided due to increased complications when treating the H&N region. The trialled treatments were all discontinued due to ineffective outcomes. Patch testing to determine possible allergens causing AD came back negative.
9/17
Why is managing AD in the head and neck region particularly challenging?
Higher risk of adverse effects from topical corticosteroids
Limited vascular supply reduces treatment efficacy
The area is difficult to access for treatment
The region is typically unaffected in atopic dermatitis
1. Chu AWL et al. Ann Allergy Asthma Immunol. 2024;132(3):274-312
Management of AD in the head and neck area is difficult because the thin and sensitive skin in these regions is more prone to adverse effects from continuous long-term use of potent topical corticosteroids; rare instances of atrophy, telangiectasia, and striae may be more likely to occur in these cases.1
10/17
Which clinical feature supports a diagnosis of chronic AD in a patient with recurrent facial and neck lesions?
Sudden onset acneiform rash
Symmetrical butterfly rash sparing the nasolabial folds
Chronic lichenified plaques with persistent pruritus
Transient erythema without scaling
Diagnosis of chronic AD is supported by the presence of persistent pruritus and lichenified plaques (thickened, leathery skin caused by repeated rubbing or scratching). Unlike other transient or acute rashes, lichenification reflects long-standing inflammation. Diagnosis is also supported by patients frequently reporting itch-scratch cycles,1 sleep disturbance,2 skin pain,3 and psychosocial distress.4
1. Chu AWL et al. Ann Allergy Asthma Immunol. 2024, 132(3):274-312 2. Chang YS, Chiang BL. J Allergy Clin Immunol. 2018;142(4):1033-40. 3. Vakharia PP et al. Ann Allergy Asthma Immunol. 2017;119(6):548-52.e3. 4. Ghio D et al. Br J Health Psychol. 2021;26(1):214-31.
11/17
Possible differential diagnoses for the patient include:
Diagnosis
Seborrhoeic dermatitis Contact dermatitis Rosacea Psoriasis
Final Diagnosis?
Confirmed diagnosis: Moderate-to-severe atopic dermatitis with head and neck involvement, based on the patient's clinical presentation, history, and investigation results
12/17
When approaching the treatment of moderate-to-severe AD, which of the following best guides the decision to initiate tralokinumab therapy?
Presence of mild symptoms localised to the hands
History of steroid phobia with well-controlled disease
Inadequate response or intolerance to topical therapies and phototherapy
First presentation of acute contact dermatitis with facial erythema
1. Adtralza® Tralokinumab Summary of Product Characteristics. 2021. Available at: https://www.ema.europa.eu/en/documents/product-information/adtralza-epar-product-information_en.pdf. Last accessed: 25 June 2025
Tralokinumab is indicated for treatment of moderate-to-severe atopic dermatitis in adult and adolescent patients 12 years and older who are candidates for systemic therapy, who had inadequate response to conventional systemic therapies.1 The decision is guided by disease severity, location (such as visible areas like the face and neck), and impact on quality of life.
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Disease control
Treatment
After diagnosis was confirmed, the patient was indicated tralokinumab and recommended lifestyle modifications.
Tralokinumab label dosing Q2W Experienced dizzy spells, not related to treatment
BSA: body surface area; EASI: Eczema Area and Severity Index; NRS: numerical Rating Scale; Q2w: once every two weeks; QoL: quality of life.
Avoidance of known triggers (e.g. certain skincare products) Stress management techniques
The patient attended regular follow-up appointments
first year of treatment
BSA: 6%
EASI: 5.6%
*Head and neck EASI: 0.9
4 years of treatment
Itch NRS: 1/10
BSA: 2% | EASI: 1.8
Improvements in QoL
*Head and neck EASI: 0.2
14/17
What is the primary mechanism of action of tralokinumab in treating AD?
Inhibition of IL-4 signalling
Neutralisation of IL-13
Suppression of TNF-α
Blockade of histamine H1 receptors
Tralokinumab, a fully human IgG4 monoclonal antibody, specifically binds with high affinity to IL-13 alone, preventing its interaction with the receptor and subsequent downstream signalling.1 By neutralising IL-13, tralokinumab disrupts inflammatory pathways responsible for skin barrier dysfunction, pruritus, and chronic inflammation.
1. Wollenberg A et al. Br J Dermatol. 2021;184(3):437-49.
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What is a reported outcome of tralokinumab treatment in patients with moderate-to-severe AD?
Increased melanin production, causing skin darkening
Increased reliance on topical corticosteroids
Higher incidence of systemic infections
Long-term improvement in skin clearance and itch relief
Evidence from long-term clinical trials support that tralokinumab provides progressive and sustained improvements in skin clearance, pruritus reduction, and quality of life over time.1,2
1. Chovatiya R et al. Long-term disease control and minimal disease activity of head and neck atopic dermatitis in patients treated with tralokinumab up to 4 years. Am J Clin Dermatol. 2025;DOI:10.1007/s40257-025-00931-1. 2. Blauvelt A et al. Long-term 2-year safety and efficacy of tralokinumab in adults with moderate-to-severe atopic dermatitis: interim analysis of the ECZTEND open-label extension trial. J Am Acad Dermatol. 2022;87(4):815-24.
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After following his treatment regimen and making lifestyle modifications, the patient experienced:
Conclusion
Significant reduction in symptoms Improved skin condition Enhanced quality of life Discontinued use of clobetasol for flares on hands
He continued ongoing management and monitoring to prevent future flare-ups.
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