July 1, 2018

Eczema or psoriasis? A special challenge in occupational dermatology

E. Weisshaar, N. Garzorz-Stark, K. Eyerich

First published: July 2018


In daily dermatological practice as in occupational dermatology, patients with psoriasis vulgaris and atopic eczema are seen frequently. These diseases may appear very similar in terms of morphology. Thus, the differentiation between nummular eczema and psoriatic plaque may form a challenge, equally between hand eczema and psoriasis manuum. So far, diagnostic classification was based on patient and family medical history, comorbidities, onset and course of disease, morphology and localization, and diagnostic tests such as allergy tests and dermatopathology. Especially the latter was not yet able to allow helpful classification. A new molecular disease classifier based on the expression of the genes NOS2 and CCL27 in lesional skin has been developed that improves the diagnostic classification of diseases such as eczema and psoriasis. This test is reliable in classical variations as well as in subtypes of the diseases. Our paper presents first experiences with this molecular classifier in a group of patients attending a clinic for occupational skin diseases. We hope that this classifier may in future be applied as a routine test in diagnostics and may possibly even allow prognostics about clinical course, comorbidities and optimal therapy. Being now a first simple diagnostic test for the differentiation between psoriasis and eczema, this classifier is most likely to achieve an important prospective role in times of personalized medicine in occupational dermatology.