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Peer-reviewedCC BY-NCJournal of the European Academy of Dermatology and Venereology

Treatment‐associated phenotype switching between psoriasis and atopic dermatitis

  • Tiago Ribeiro Torres1,2
  • Mario Valenti3,4
  • Anna Balato5
  • Matteo Megna6
  • Paolo Gisondi7
  • Vimal H. Prajapati8,9,10,11
  • Stefano Piaserico12
  • Julia‐Tatjana Maul13,14
  • Lara Valeska Maul13,14
  • J.M. Carrascosa15
  • F.J. Navarro‐Triviño16,17
  • Elizabeth Lazaridou18
17 more authors
  • César Ferreira1
  • Jacopo Tartaglia12
  • Christian Ciolfi12
  • Athina‐Ioanna Daponte18
  • Eugenia Veronica Di Brizzi5
  • Maddalena Napolitano4
  • Barbara Guerra Leal19
  • Mónica Munera‐Campos15
  • Siddhartha Sood20
  • Silvia Ferruci21,22
  • Francesca Prignano23
  • Esteban Daudén24
  • Mar Llamas‐Velasco24
  • Ronald B. Vender25,26
  • Jensen Yeung20,27
  • Angelo Valerio Marzano21,22
  • L. Puig28
28 affiliations
  1. 1Department of Dermatology Centro Académico Clínico ICBAS/Santo António Porto Portugal
  2. 2Instituto de Ciências Biomédicas Abel Salazar University of Porto Porto Portugal
  3. 3Department of Biomedical Sciences Humanitas University Milan Italy
  4. 4Dermatology Unit IRCCS Humanitas Research Hospital Milan Italy
  5. 5Unit of Dermatology University of Campania Luigi Vanvitelli Naples Italy
  6. 6Section of Dermatology, Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy
  7. 7Department of Dermatology University of Verona Verona Italy
  8. 8Division of Dermatology, Department of Medicine University of Calgary Calgary Canada
  9. 9Probity Medical Research Calgary Canada
  10. 10Section of Community Pediatrics and Pediatric Rheumatology, Department of Pediatrics University of Calgary Calgary Canada
  11. 11Skin Health & Wellness Centre Calgary Canada
  12. 12Department of Dermatology University of Padua Padua Italy
  13. 13Department of Dermatology University Hospital Zürich Zürich Switzerland
  14. 14Faculty of Medicine University of Zürich Zürich Switzerland
  15. 15Servicio de Dermatología Hospital Universitari Germans Trias i Pujol, IGTP, UAB Barcelona Spain
  16. 16Cutaneous Immunoallergy Unit, Dermatology Department San Cecilio University Hospital Granada Spain
  17. 17Institute for Biomedical Research IBS Granada Spain
  18. 18Second Department of Dermatology‐Venereology Aristotle University School of Medicine Thessaloniki Greece
  19. 19Unit for Multidisciplinary Research in Biomedicine, School of Medicine and Biomedical Sciences University of Porto Porto Portugal
  20. 20Division of Dermatology, Department of Medicine University of Toronto Toronto Ontario Canada
  21. 21Department of Pathophysiology and Transplantation Università Degli Studi di Milano Milan Italy
  22. 22Dermatology Unit Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
  23. 23Department of Health Sciences, Section of Dermatology University of Florence Florence Italy
  24. 24Department of Dermatology Hospital Universitario de La Princesa Instituto de Investigación Sanitaria de La Princesa (IIS‐IP) Madrid Spain
  25. 25Dermatrials Research Inc. & Venderm Consulting Hamilton Ontario Canada
  26. 26Division of Dermatology McMaster University Hamilton Ontario Canada
  27. 27Division of Dermatology, Department of Medicine Women's College Hospital Toronto Canada
  28. 28Department of Dermatology Hospital de la Santa Creu i Sant Pau and Universitat Autònoma de Barcelona School of Medicine Barcelona Spain
Open at sourceDOICite

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.

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Cite

BibTeXRIS
BibTeX
@article{torres2026treatmentassociated,
  title = {{Treatment‐associated phenotype switching between psoriasis and atopic dermatitis}},
  author = {Tiago Ribeiro Torres and Mario Valenti and Anna Balato and Matteo Megna and Paolo Gisondi and Vimal H. Prajapati and Stefano Piaserico and Julia‐Tatjana Maul and Lara Valeska Maul and J.M. Carrascosa and F.J. Navarro‐Triviño and Elizabeth Lazaridou and César Ferreira and Jacopo Tartaglia and Christian Ciolfi and Athina‐Ioanna Daponte and Eugenia Veronica Di Brizzi and Maddalena Napolitano and Barbara Guerra Leal and Mónica Munera‐Campos and Siddhartha Sood and Silvia Ferruci and Francesca Prignano and Esteban Daudén and Mar Llamas‐Velasco and Ronald B. Vender and Jensen Yeung and Angelo Valerio Marzano and L. Puig},
  journal = {Journal of the European Academy of Dermatology and Venereology},
  year = {2026},
  month = may,
  doi = {10.1111/jdv.70503},
  url = {https://doi.org/10.1111/jdv.70503},
  note = {CC BY-NC},
}
RIS
TY  - JOUR
TI  - Treatment‐associated phenotype switching between psoriasis and atopic dermatitis
AU  - Tiago Ribeiro Torres
AU  - Mario Valenti
AU  - Anna Balato
AU  - Matteo Megna
AU  - Paolo Gisondi
AU  - Vimal H. Prajapati
AU  - Stefano Piaserico
AU  - Julia‐Tatjana Maul
AU  - Lara Valeska Maul
AU  - J.M. Carrascosa
AU  - F.J. Navarro‐Triviño
AU  - Elizabeth Lazaridou
AU  - César Ferreira
AU  - Jacopo Tartaglia
AU  - Christian Ciolfi
AU  - Athina‐Ioanna Daponte
AU  - Eugenia Veronica Di Brizzi
AU  - Maddalena Napolitano
AU  - Barbara Guerra Leal
AU  - Mónica Munera‐Campos
AU  - Siddhartha Sood
AU  - Silvia Ferruci
AU  - Francesca Prignano
AU  - Esteban Daudén
AU  - Mar Llamas‐Velasco
AU  - Ronald B. Vender
AU  - Jensen Yeung
AU  - Angelo Valerio Marzano
AU  - L. Puig
PY  - 2026
DA  - 2026/05/14
JO  - Journal of the European Academy of Dermatology and Venereology
DO  - 10.1111/jdv.70503
UR  - https://doi.org/10.1111/jdv.70503
AB  - 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.
SN  - 0926-9959
SN  - 1468-3083
ER  -