A retrospective descriptive study of oral azole antifungal agents in patients with patch test-negative head and neck predominant atopic dermatitis

Background: Head and neck dermatitis is a subtype of atopic dermatitis driven by Malassezia yeast. Objective: We sought to evaluate the response of these patients to systemic azole antifungals. Methods: We queried the electronic medical records from our institution for patients that were referred for allergy patch testing, were ultimately given the diagnosis of head and neck dermatitis, and were treated with oral azole antifungals over a 2-year period. Results: Twenty-four patients met inclusion criteria and were analyzed. Most patients noted their characteristic flare beginning during their teenage, young adult, or adult years. All were noted to have some involvement of the head and neck, and 17 responded to treatment. The mean time taking an azole antifungal medication was 8 months, with a mean overall follow-up of 10 months. Limitations: This was a retrospective descriptive study, from a single institution, of a limited number of patients, and did not use a validated scoring system. Conclusion: Itraconazole and other azole antifungals were an effective treatment for more than two-thirds of adult patients with head and neck predominant atopic dermatitis.