Psoriasis-Atopic Dermatitis Overlap Phenotype Presents Diagnostic and Therapeutic Challenges
Patients exhibiting overlapping features of psoriasis (PsO) and atopic dermatitis (AD) may present distinct diagnostic and therapeutic challenges due to mixed inflammatory pathways, according to a review examining the pathogenesis, clinical presentation, and treatment considerations of the PsO-AD overlap phenotype.
Although PsO and AD are traditionally recognized as separate chronic inflammatory skin diseases, a subset of patients demonstrates clinical and immunologic characteristics associated with both conditions. The review highlighted how these overlapping features may complicate disease classification and treatment selection.
PsO is primarily characterized by T helper (Th) 1 and Th17 immune responses, whereas AD predominantly involves Th2-mediated inflammation. However, patients with the overlap phenotype exhibit simultaneous activation of inflammatory pathways associated with both diseases.
The authors described this phenotype as a “unique clinical entity” characterized by mixed Th17/Th2 immune responses, including elevated levels of interleukin (IL)-17A, IL-23, IL-4, and IL-13.
These cytokines represent inflammatory pathways typically associated with PsO or AD, suggesting that the overlap phenotype may require a more individualized approach to disease assessment and therapeutic decision-making.
The review also examined the potential contributions of genetic predisposition, immunologic dysregulation, and environmental factors to the development of overlapping disease features. Understanding how these mechanisms interact may help clarify the biologic basis of the phenotype and improve its clinical recognition.
Emerging biomarker-guided approaches were identified as potential strategies for improving treatment precision. By better characterizing the inflammatory pathways involved in individual patients, these approaches may eventually help clinicians navigate therapeutic decisions when conventional disease classifications are insufficient.
The authors noted that recent insights into the genetic, immunologic, and environmental contributors to the overlap phenotype, “alongside emerging biomarker-guided therapies, offer potential for more precise management.”
Reference
Marzouk S, Lio P. Psoriasis and atopic dermatitis overlap: pathogenesis and therapeutic considerations for the clinician. Dermatitis. 2026;37(6):886-893. doi:10.1177/17103568251378145
