Reviews Open access

Otolaryngologic-cutaneous associations, mechanisms, and diagnostic distinctions: a narrative review

Authors

Published
9 November 2026
Section
Reviews
DOI
10.4081/ahr.2026.213

Abstract

Reported otolaryngologic-cutaneous relationships arise through distinct mechanisms, including direct infectious spread, shared inflammatory predisposition, local sensory-neuroimmune signaling, and neuropathic-like symptoms without nerve injury. This structured narrative review evaluates clinical and translational evidence for these categories and distinguishes neurogenic inflammation from neuropathic pain and itch. PubMed/MEDLINE was searched through August 12, 2026, with supplementary targeted association searches on September 1, 2026. Acute bacterial rhinosinusitis may cause periorbital or orbital cellulitis through direct anatomic spread. Associations of chronic rhinosinusitis with rosacea and allergic rhinitis with atopic dermatitis or eczema remain observational and do not establish causality or temporal sequence. Sensory-neuropeptide signaling is best established for pruritus and remains suggestive for rosacea. Intense or persistent nociceptor activation can amplify neurogenic inflammation and produce burning, stinging, itch, or allodynia that resembles neuropathic symptoms without the somatosensory lesion required for neuropathic disease. Clinical evaluation should classify findings as infectious, shared inflammatory or atopic, neurogenic inflammatory, neuropathic-like, or neuropathic and should direct treatment to the established disorder. Human evidence does not support targeted treatment of a shared otolaryngologic-cutaneous neuroimmune pathway.

Keywords

References

  1. 1. Spekker E, Tanaka M, Szabó Á, Vécsei L. Neurogenic inflammation: the participant in migraine and recent advancements in translational research. Biomedicines 2021;10:76. DOI: https://doi.org/10.3390/biomedicines10010076
  2. 2. Chiu IM, Von Hehn CA, Woolf CJ. Neurogenic inflammation and the peripheral nervous system in host defense and immunopathology. Nat Neurosci 2012;15:1063-7. DOI: https://doi.org/10.1038/nn.3144
  3. 3. Finnerup NB, Haroutounian S, Kamerman P, et al. Neuropathic pain: an updated grading system for research and clinical practice. Pain 2016;157:1599-606. DOI: https://doi.org/10.1097/j.pain.0000000000000492
  4. 4. Shirley SN, Watson AE, Yusuf N. Pathogenesis of inflammation in skin disease: from molecular mechanisms to pathology. Int J Mol Sci 2024;25:10152. DOI: https://doi.org/10.3390/ijms251810152
  5. 5. Baethge C, Goldbeck-Wood S, Mertens S. SANRA-a scale for the quality assessment of narrative review articles. Res Integr Peer Rev 2019;4:5. DOI: https://doi.org/10.1186/s41073-019-0064-8
  6. 6. Yam MF, Loh YC, Tan CS, et al. General pathways of pain sensation and the major neurotransmitters involved in pain regulation. Int J Mol Sci 2018;19:2164. DOI: https://doi.org/10.3390/ijms19082164
  7. 7. Cevikbas F, Lerner EA. Physiology and pathophysiology of itch. Physiol Rev 2020;100:945-82. DOI: https://doi.org/10.1152/physrev.00017.2019
  8. 8. Devigili G, Rinaldo S, Lombardi R, et al. Diagnostic criteria for small fibre neuropathy in clinical practice and research. Brain 2019;142:3728-36. DOI: https://doi.org/10.1093/brain/awz333
  9. 9. Meggs WJ. Neurogenic switching: a hypothesis for a mechanism for shifting the site of inflammation in allergy and chemical sensitivity. Environ Health Perspect 1995;103:54-6. DOI: https://doi.org/10.1289/ehp.9510354
  10. 10. Lovrenčić L, Matak I, Lacković Z. Association of intranasal and neurogenic dural inflammation in experimental acute rhinosinusitis. Front Pharmacol 2020;11:586037. DOI: https://doi.org/10.3389/fphar.2020.586037
  11. 11. Shankar S, Mohanty R, Satpathy A, et al. Neurogenic switching mechanism: probable link between periodontal disease and systemic diseases: a review. Indian J Public Health Res Dev 2019;10:990. DOI: https://doi.org/10.5958/0976-5506.2019.03628.3
  12. 12. De Bartolomeis F, Savoia A, Aitella E, et al. Urticaria by neurogenic switching of gastroesophageal chemical‐infective inflammation: a phenomenon that should always be evaluated in suspected multiple drug hypersensitivity. Clin Transl Allergy 2014;4:P26. DOI: https://doi.org/10.1186/2045-7022-4-S3-P26
  13. 13. Levy RM, Rose JE, Johnson JS. Effect of vagotomy on anaphylaxis in the rat. Clin Exp Immunol 1976;24:96-101.
  14. 14. Leslie C, Mathe A. Modification of guinea pig lung anaphylaxis by central nervous system (CNS) perturbations1, 2. J Allergy Clin Immunol 1989;83:94-101. DOI: https://doi.org/10.1016/0091-6749(89)90482-X
  15. 15. Kwon E, Hathaway C, Sutton AE. Acute sinusitis. Treasure Island, StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK547701/
  16. 16. Battisti AS, Pangia J, Modi P. Sinusitis (Archived). Treasure Island, StatPearls Publishing; 2024. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470383/
  17. 17. Zeppieri M, Bourget D. Periorbital cellulitis. Treasure Island, StatPearls Publishing; 2024. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470408/
  18. 18. Capobianco M, Zeppieri M. Orbital cellulitis. Treasure Island, StatPearls Publishing; 2024. Available from: http://www.ncbi.nlm.nih.gov/books/NBK507901/
  19. 19. Rainer BM, Kang S, Chien AL. Rosacea: epidemiology, pathogenesis, and treatment. Dermatoendocrinol 2017;9:e1361574. DOI: https://doi.org/10.1080/19381980.2017.1361574
  20. 20. Ooi EH, Wormald PJ, Carney AS, James CL, Tan LW. Human cathelicidin antimicrobial peptide is up-regulated in the eosinophilic mucus subgroup of chronic rhinosinusitis patients. Am J Rhinol 2007;21:395-401. DOI: https://doi.org/10.2500/ajr.2007.21.3048
  21. 21. Farshchian M, Daveluy S. Rosacea. Treasure Island, StatPearls Publishing; 2024. Available from: http://www.ncbi.nlm.nih.gov/books/NBK557574/
  22. 22. Al-Balbeesi AO. Rosacea and chronic rhinosinusitis: a case-controlled study. Med Princ Pract Int J Kuwait Univ Health Sci Cent 2014;23:511-6. DOI: https://doi.org/10.1159/000364905
  23. 23. Nur Husna SM, Tan HTT, Md Shukri N, et al. Allergic rhinitis: a clinical and pathophysiological overview. Front Med 2022;9:874114. DOI: https://doi.org/10.3389/fmed.2022.874114
  24. 24. Galli SJ, Tsai M. IgE and mast cells in allergic disease. Nat Med 2012;18:693-704. DOI: https://doi.org/10.1038/nm.2755
  25. 25. Deo SS, Mistry KJ, Kakade AM, Niphadkar PV. Role played by Th2 type cytokines in IgE mediated allergy and asthma. Lung India 2010;27:66-71. DOI: https://doi.org/10.4103/0970-2113.63609
  26. 26. Kolb L, Villareal LA, Sathe NC. Atopic dermatitis. Treasure Island, StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448071/
  27. 27. Nemeth V, Syed HA, Evans J. Eczema Atopic dermatitis. Treasure Island, StatPearls Publishing; 2024. Available from: http://www.ncbi.nlm.nih.gov/books/NBK538209/
  28. 28. Steiner UC, Bachmann LM, Soyka MB, et al. Relationship between rhinitis, asthma, and eczema and the presence of sensitization in young Swiss adults. Allergy Rhinol (Providence) 2018;9:2152656718773606. DOI: https://doi.org/10.1177/2152656718773606
  29. 29. van Zuuren EJ, Arents BWM, van der Linden MMD, et al. Rosacea: new concepts in classification and treatment. Am J Clin Dermatol 2021;22:457-65. DOI: https://doi.org/10.1007/s40257-021-00595-7
  30. 30. Ahn CS, Huang WW. Rosacea pathogenesis. Dermatol Clin 2018;36:81-6. DOI: https://doi.org/10.1016/j.det.2017.11.001
  31. 31. Liu T, Xiao W, Chen M, et al. Aberrant amino acid metabolism promotes neurovascular reactivity in rosacea. JCI Insight 2022;7:e161870. DOI: https://doi.org/10.1172/jci.insight.161870
  32. 32. NYU Langone Health [Internete]. Types of Rosacea. Accessed: October 1, 2024. Available from: https://nyulangone.org/conditions/rosacea/types
  33. 33. Shanler SD, Ondo AL. Successful treatment of the erythema and flushing of rosacea using a topically applied selective α1-adrenergic receptor agonist, oxymetazoline. Arch Dermatol 2007;143:1369-71. DOI: https://doi.org/10.1001/archderm.143.11.1369
  34. 34. Center for Disease Control and Prevention [Internet]. Shingles facts and stats. Shingles (Herpes Zoster). Accessed: August 11, 2024. Available from: https://www.cdc.gov/shingles/data-research/index.html
  35. 35. Gruver C, Guthmiller KB. Postherpetic neuralgia. Treasure Island, StatPearls Publishing; 2023. Available from: http://www.ncbi.nlm.nih.gov/books/NBK493198/
  36. 36. Saguil A, Kane S, Mercado M, Lauters R. Herpes zoster and postherpetic neuralgia: prevention and management. Am Fam Physician 2017;96:656-63.
  37. 37. Lauria G, Devigili G. Skin biopsy as a diagnostic tool in peripheral neuropathy. Nat Clin Pract Neurol 2007;3:546-57. DOI: https://doi.org/10.1038/ncpneuro0630
  38. 38. McKay M. The dermatologic history (Chapter 14). In: Walker HK, Hall WD, Hurst JW, editors. Clinical methods: the history, physical, and laboratory examinations, 3rd ed. Boston, Butterworths; 1990.
  39. 39. Novello BJ, Pobre T. Electrodiagnostic evaluation of peripheral neuropathy. Treasure Island, StatPearls Publishing; 2023. Available from: http://www.ncbi.nlm.nih.gov/books/NBK563169/
  40. 40. Holm AF, Fokkens WJ. Topical corticosteroids in allergic rhinitis; effects on nasal inflammatory cells and nasal mucosa. Clin Exp Allergy 2001;31:529-35. DOI: https://doi.org/10.1046/j.1365-2222.2001.01091.x
  41. 41. Godthelp T, Holm AF, Blom H, et al. The effect of fluticasone propionate aqueous nasal spray on nasal mucosal inflammation in perennial allergic rhinitis. Allergy 1995;50:21-4. DOI: https://doi.org/10.1111/j.1398-9995.1995.tb02737.x
  42. 42. Holm AF, Godthelp T, Fokkens WJ, et al. Long‐term effects of corticosteroid nasal spray on nasal inflammatory cells in patients with perennial allergic rhinitis. Clin Exp Allergy 1999;29:1356-66. DOI: https://doi.org/10.1046/j.1365-2222.1999.00665.x
  43. 43. Van Cauwenberge P, Van Hoecke H, Vandenbulcke L, et al. Glucocorticosteroids in allergic inflammation: clinical benefits in allergic rhinitis, rhinosinusitis, and otitis media. Immunol Allergy Clin North Am 2005;25:489-509. DOI: https://doi.org/10.1016/j.iac.2005.05.001
  44. 44. Linton S, Hossenbaccus L, Ellis AK. Evidence-based use of antihistamines for treatment of allergic conditions. Ann Allergy Asthma Immunol 2023;131:412-20. DOI: https://doi.org/10.1016/j.anai.2023.07.019
  45. 45. Eschler DC, Klein PA. An evidence-based review of the efficacy of topical antihistamines in the relief of pruritus. J Drugs Dermatol 2010;9:992-7.
  46. 46. Li J, Tian Y, Wu A. Neuropeptide Y receptors: a promising target for cancer imaging and therapy. Regen Biomater 2015;2:215-9. DOI: https://doi.org/10.1093/rb/rbv013
  47. 47. Hargreaves R, Ferreira JCA, Hughes D, et al. Development of aprepitant, the first neurokinin‐1 receptor antagonist for the prevention of chemotherapy‐induced nausea and vomiting. Ann N Y Acad Sci 2011;1222:40-8. DOI: https://doi.org/10.1111/j.1749-6632.2011.05961.x
  48. 48. Sanger GJ. Neurokinin NK 1 and NK 3 receptors as targets for drugs to treat gastrointestinal motility disorders and pain. Br J Pharmacol 2004;141:1303-12. DOI: https://doi.org/10.1038/sj.bjp.0705742
  49. 49. Van Schoor J, Joos G, Chasson B, et al. The effect of the NK2 tachykinin receptor antagonist SR 48968 (saredutant) on neurokinin A-induced bronchoconstriction in asthmatics. Eur Respir J 1998;12:17-23. DOI: https://doi.org/10.1183/09031936.98.12010017
  50. 50. Sun P, Li H, Xu Q, et al. Lidocaine alleviates inflammation and pruritus in atopic dermatitis by blocking different population of sensory neurons. Br J Pharmacol 2023;180:1339-61. DOI: https://doi.org/10.1111/bph.16012

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