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- Presentation
Psoriasis or Eczema? Understanding Overlap Phenotypes and Immune Pathways
Description
The talk addressed the diagnostic and therapeutic overlap between psoriasis and atopic dermatitis (eczema), emphasizing that these conditions are better viewed as part of a spectrum rather than a strict dichotomy. The speaker described difficult cases with mixed clinical and histologic features, then reviewed evidence that overlap phenotypes share pathogenic pathways such as IL-17, IL-22, barrier dysfunction, and genetic factors. She highlighted paradoxical reactions to biologics: dupilumab can trigger psoriasiform eruptions, while psoriasis biologics can sometimes induce eczema-like disease. Studies in children and adults showed that overlap patients often have intermediate clinical features, and molecular profiling placed most of them closer to psoriasis, suggesting a psoriasis-dominant spectrum rather than a separate disease. The talk also discussed emerging diagnostic tools, including molecular classifiers and gene-expression signatures, and proposed more precise treatment based on the dominant immune pathway, using IL-17/IL-23 blockade for psoriasis-predominant cases, IL-4/IL-13 blockade for eczema-predominant cases, and JAK inhibitors for mixed inflammatory profiles. Overall, the message was to diagnose broadly, recognize overlap phenotypes, and tailor therapy to the underlying immune pattern.
View moreConclusions
- Psoriasis and atopic dermatitis are best understood as a continuous immunologic spectrum rather than two completely separate diseases.
- Overlapping or intermediate phenotypes are clinically real and often harder to diagnose than classic psoriasis or eczema.
- Clinical features alone and even histopathology may be insufficient to reliably distinguish overlap cases from pure psoriasis or atopic dermatitis.
- Molecular profiling suggests that most overlap phenotypes are closer to psoriasis than to atopic dermatitis.
- Overlap disease can evolve over time in either direction, showing that it is a dynamic transitional state rather than a fixed entity.
- Biologic therapies can alter immune balance and trigger paradoxical psoriasis- or eczema-like eruptions.
- Patients with prior atopic disease appear to be at higher risk for paradoxical eczema during biologic treatment, while IL-23 inhibitors seem to carry lower risk than some other classes.
- Management should be guided by the dominant immune pathway rather than by rigid disease labels alone.
- Broader diagnostic thinking and pathway-directed treatment are recommended for patients with mixed psoriasis-eczema presentations.
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