September 14, 2023

Back to Broad? How Molecular Profiling Facilitates Targeted Therapies of Overlapping Phenotypes

Kilian Eyerich, Natalie Garzorz-Stark

First published: 14 September 2023


Psoriasis and eczema are noncommunicable inflammatory skin diseases (ncISDs) that may present with overlapping clinical and histopathological features, making their differential diagnosis a pertinent challenge for clinicians. Treatments with highly effective mAbs for psoriasis and eczema are increasingly replacing broadly acting immunosuppressant drugs such as methotrexate and cyclosporine. However, because antibodies targeting the IL-23/T helper (Th)17 axis in psoriasis and the IL-4/Th2 axis in eczema address fundamentally distinct modes of action, misdiagnosed patients may not only receive ineffective but even harmful therapies. Hence, clinicians face challenges when choosing the appropriate drug for overlapping patients because there are no guidelines for biological use in mixed-type variants. Consequently, those patients may not benefit from recent therapeutic advances and receive immunosuppressants instead. To make targeted treatment options also available for overlapping and indistinct phenotypes, research needs to be focused on these entities. The results of the study by Kim et al. (2023) “Genomic profiling of the overlap phenotype between psoriasis and atopic dermatitis” provide meaningful insights into the molecular signature of overlapping psoriasis and eczema phenotypes in a South Korean cohort of patients with psoriasis and eczema that may suggest future treatment algorithms.