Fungal Head and Neck Dermatitis: Current Understanding and Management.

IF 8.4 2区 医学 Q1 ALLERGY Clinical Reviews in Allergy & Immunology Pub Date : 2024-06-01 Epub Date: 2024-07-20 DOI:10.1007/s12016-024-09000-7
Albert C Chong, Francisco José Navarro-Triviño, Malcolm Su, Chang Ook Park
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Abstract

Head and neck dermatitis (HND) is a form of atopic dermatitis (AD) that affects the seborrheic areas of the body and causes greater quality of life detriments than other types of AD. HND can be challenging to treat since first-line topical therapies may be ineffective or intolerable for long-term use on areas affected by HND while dupilumab may cause dupilumab-associated HND (DAHND). Current evidence implicates fungi, particularly Malassezia spp., in the pathogenesis of HND. Penetration of fungal antigens through the defective AD skin barrier activates the innate and adaptive immune systems to cause cutaneous inflammation via the T helper (Th)17 and/or Th2 axes. Malassezia sensitization may distinguish HND from other forms of AD. Multiple double-blind, placebo-controlled trials have shown antifungals to benefit HND, yet the persistence of symptom relief with sustained use remains unclear. Oral antifungals appear more effective than topical antifungals but may be harmful with long-term use. DAHND may also be fungal-mediated given improvement with antifungals and evidence of an overactive immune response against Malassezia in these patients. Janus kinase inhibitors are effective for HND, including DAHND, but may cause significant side effects when administered systemically. OX40/OX40L inhibitors and tralokinumab may be promising options for HND on the horizon. Demographic and environmental factors influence the host mycobiome and should be considered in future precision-medicine approaches as microbiome composition and diversity are linked to severity of HND.

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真菌性头颈部皮炎:当前的认识和管理。
头颈部皮炎(HND)是特应性皮炎(AD)的一种,会影响身体的皮脂溢出部位,与其他类型的特应性皮炎相比,对生活质量的影响更大。HND 的治疗具有挑战性,因为一线外用疗法可能无效,或长期用于受 HND 影响的部位无法忍受,而杜匹单抗可能导致杜匹单抗相关 HND(DAHND)。目前的证据表明,真菌,尤其是马拉色菌属与 HND 的发病机制有关。真菌抗原通过有缺陷的 AD 皮肤屏障渗透,激活先天性和适应性免疫系统,通过 T 辅助细胞 (Th)17 和/或 Th2 轴引起皮肤炎症。马拉色菌致敏可将 HND 与其他形式的 AD 区分开来。多项双盲安慰剂对照试验表明,抗真菌药物对 HND 有益,但持续使用后症状缓解的持久性仍不明确。口服抗真菌药似乎比外用抗真菌药更有效,但长期使用可能有害。DAHND 也可能是由真菌介导的,因为这些患者使用抗真菌药物后症状有所改善,而且有证据表明他们对马拉色菌的免疫反应过于活跃。Janus 激酶抑制剂对 HND(包括 DAHND)有效,但全身用药时可能会产生严重的副作用。OX40/OX40L抑制剂和曲妥珠单抗可能是治疗HND的前景看好的选择。人口和环境因素会影响宿主真菌生物群,在未来的精准医疗方法中应加以考虑,因为微生物群的组成和多样性与 HND 的严重程度有关。
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来源期刊
CiteScore
22.30
自引率
1.10%
发文量
58
审稿时长
6-12 weeks
期刊介绍: Clinical Reviews in Allergy & Immunology is a scholarly journal that focuses on the advancement of clinical management in allergic and immunologic diseases. The journal publishes both scholarly reviews and experimental papers that address the current state of managing these diseases, placing new data into perspective. Each issue of the journal is dedicated to a specific theme of critical importance to allergists and immunologists, aiming to provide a comprehensive understanding of the subject matter for a wide readership. The journal is particularly helpful in explaining how novel data impacts clinical management, along with advancements such as standardized protocols for allergy skin testing and challenge procedures, as well as improved understanding of cell biology. Ultimately, the journal aims to contribute to the improvement of care and management for patients with immune-mediated diseases.
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