{
  "abstract": "Psoriasis and atopic dermatitis (AD) are traditionally viewed as distinct inflammatory skin diseases driven by type 17 and type 2 immune pathways, respectively. Increasing use of targeted therapies has revealed a treatment-associated phenotype switch between these conditions, the so-called 'flip-flop' phenomenon, characterized by sustained emergence of eczematous features in patients treated for psoriasis or psoriasiform disease in those treated for AD. Robust real-world data on this entity remain limited. OBJECTIVES: To characterize treatment-associated phenotype switching between psoriasis and AD in a large real-world cohort, focusing on clinical features, implicated therapies, management strategies and outcomes. METHODS: We conducted a retrospective, multicentre, multinational observational study across 17 dermatology centres in six countries. Patients with psoriasis or AD who developed a clinician-defined, persistent phenotype switch temporally associated with systemic or biologic therapy and requiring treatment modification were included. Demographic, clinical, therapeutic and outcome data were collected and analysed descriptively. RESULTS: A total of 148 patients were included: 101 (68.2%) developed eczematous features while treated for psoriasis (PsO → eczematous), and 47 (31.8%) developed psoriasiform disease while treated for AD (AD → psoriasiform). PsO → eczematous patients were older and had more cardiometabolic comorbidities, whereas atopic comorbidities were more frequent in the AD → psoriasiform group. PsO → eczematous switches occurred mainly under interleukin (IL)-17 and IL-23 inhibitors, while AD → psoriasiform switches occurred exclusively during biologic therapies targeting type 2 inflammation, predominantly dupilumab. Treatment was modified in all patients. Janus kinase (JAK) inhibitors were the most frequently used strategy in both switch directions, particularly in PsO → eczematous cases. Marked clinical improvement was observed across phenotypes following therapeutic adjustment. CONCLUSIONS: Treatment-associated phenotype switching between psoriasis and AD is a reproducible, bidirectional and clinically relevant real-world phenomenon reflecting immune plasticity rather than paradoxical disease induction. Recognition of this entity is essential to guide appropriate therapeutic adaptation, with JAK inhibitors emerging as a commonly effective management option.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Dermatology Centro Académico Clínico ICBAS/Santo António Porto Portugal",
    "Instituto de Ciências Biomédicas Abel Salazar University of Porto Porto Portugal",
    "Department of Biomedical Sciences Humanitas University Milan Italy",
    "Dermatology Unit IRCCS Humanitas Research Hospital Milan Italy",
    "Unit of Dermatology University of Campania Luigi Vanvitelli Naples Italy",
    "Section of Dermatology, Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy",
    "Department of Dermatology University of Verona Verona Italy",
    "Division of Dermatology, Department of Medicine University of Calgary Calgary Canada",
    "Probity Medical Research Calgary Canada",
    "Section of Community Pediatrics and Pediatric Rheumatology, Department of Pediatrics University of Calgary Calgary Canada",
    "Skin Health & Wellness Centre Calgary Canada",
    "Department of Dermatology University of Padua Padua Italy",
    "Department of Dermatology University Hospital Zürich Zürich Switzerland",
    "Faculty of Medicine University of Zürich Zürich Switzerland",
    "Servicio de Dermatología Hospital Universitari Germans Trias i Pujol, IGTP, UAB Barcelona Spain",
    "Cutaneous Immunoallergy Unit, Dermatology Department San Cecilio University Hospital Granada Spain",
    "Institute for Biomedical Research IBS Granada Spain",
    "Second Department of Dermatology‐Venereology Aristotle University School of Medicine Thessaloniki Greece",
    "Unit for Multidisciplinary Research in Biomedicine, School of Medicine and Biomedical Sciences University of Porto Porto Portugal",
    "Division of Dermatology, Department of Medicine University of Toronto Toronto Ontario Canada",
    "Department of Pathophysiology and Transplantation Università Degli Studi di Milano Milan Italy",
    "Dermatology Unit Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy",
    "Department of Health Sciences, Section of Dermatology University of Florence Florence Italy",
    "Department of Dermatology Hospital Universitario de La Princesa Instituto de Investigación Sanitaria de La Princesa (IIS‐IP) Madrid Spain",
    "Dermatrials Research Inc. & Venderm Consulting Hamilton Ontario Canada",
    "Division of Dermatology McMaster University Hamilton Ontario Canada",
    "Division of Dermatology, Department of Medicine Women's College Hospital Toronto Canada",
    "Department of Dermatology Hospital de la Santa Creu i Sant Pau and Universitat Autònoma de Barcelona School of Medicine Barcelona Spain"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 29,
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    {
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        0,
        1
      ],
      "name": "Tiago Ribeiro Torres",
      "orcid": "0000-0003-0404-0870"
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        3
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      "name": "Mario Valenti",
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      "orcid": "0000-0003-1803-2046"
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      "name": "Paolo Gisondi",
      "orcid": "0000-0002-1777-9001"
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    {
      "affs": [
        7,
        8,
        9,
        10
      ],
      "name": "Vimal H. Prajapati",
      "orcid": "0000-0002-8315-2522"
    },
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        11
      ],
      "name": "Stefano Piaserico",
      "orcid": "0000-0002-1091-4733"
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        12,
        13
      ],
      "name": "Julia‐Tatjana Maul",
      "orcid": "0000-0002-9914-1545"
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    {
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        12,
        13
      ],
      "name": "Lara Valeska Maul",
      "orcid": "0000-0001-9202-0073"
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    {
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      ],
      "name": "J.M. Carrascosa",
      "orcid": "0000-0003-4266-0771"
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    {
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        15,
        16
      ],
      "name": "F.J. Navarro‐Triviño",
      "orcid": "0000-0002-5454-3671"
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    {
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        17
      ],
      "name": "Elizabeth Lazaridou",
      "orcid": "0000-0002-4072-3591"
    },
    {
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        0
      ],
      "name": "César Ferreira"
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    {
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        11
      ],
      "name": "Jacopo Tartaglia",
      "orcid": "0000-0001-8838-7649"
    },
    {
      "affs": [
        11
      ],
      "name": "Christian Ciolfi",
      "orcid": "0000-0002-9098-4124"
    },
    {
      "affs": [
        17
      ],
      "name": "Athina‐Ioanna Daponte",
      "orcid": "0000-0002-4733-2585"
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    {
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        4
      ],
      "name": "Eugenia Veronica Di Brizzi",
      "orcid": "0000-0002-0278-2443"
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    {
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        3
      ],
      "name": "Maddalena Napolitano",
      "orcid": "0000-0003-3309-8190"
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    {
      "affs": [
        18
      ],
      "name": "Barbara Guerra Leal"
    },
    {
      "affs": [
        14
      ],
      "name": "Mónica Munera‐Campos",
      "orcid": "0000-0002-2227-2993"
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    {
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        19
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      "name": "Siddhartha Sood",
      "orcid": "0000-0003-3531-5961"
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    {
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        20,
        21
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      "name": "Silvia Ferruci"
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        22
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      "name": "Francesca Prignano",
      "orcid": "0000-0002-5997-2045"
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        23
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      "name": "Esteban Daudén",
      "orcid": "0000-0002-0676-1260"
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    {
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        23
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      "name": "Mar Llamas‐Velasco",
      "orcid": "0000-0002-1187-1341"
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        24,
        25
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      "name": "Ronald B. Vender",
      "orcid": "0000-0002-2624-2724"
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        26
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      "name": "Jensen Yeung",
      "orcid": "0000-0002-7318-5515"
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        21
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      "name": "Angelo Valerio Marzano",
      "orcid": "0000-0002-8160-4169"
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    {
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        27
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      "name": "L. Puig",
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  "bibtex": "https://research.draconitic.com/paper/d1sr6mqmnhaej.bib",
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  "doi": "10.1111/jdv.70503",
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  "language": "en",
  "licence": "CC-BY-NC",
  "licence_label": "CC BY-NC",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
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      "2403|Psoriasis: Treatment and Pathogenesis"
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  "pmcid": "PMC13695782",
  "pmid": "42132049",
  "published": "2026-05-14",
  "publisher": "Wiley",
  "ris": "https://research.draconitic.com/paper/d1sr6mqmnhaej.ris",
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      "first_seen": "2026-10-30T13:26:51Z",
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  "subjects": [
    {
      "field": "biology",
      "origin": "openalex:2403|Psoriasis: Treatment and Pathogenesis",
      "subfield": "immunology"
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  "title": "Treatment‐associated phenotype switching between psoriasis and atopic dermatitis",
  "title_text": "Treatment‐associated phenotype switching between psoriasis and atopic dermatitis",
  "type": "peer-reviewed",
  "updated_at": "2026-11-08T13:20:46Z",
  "url": "https://research.draconitic.com/paper/d1sr6mqmnhaej",
  "venue": "Journal of the European Academy of Dermatology and Venereology",
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