Psoriasis–AD Switching May Mimic Treatment Failure

Recognizing sustained switches between the two diseases can prevent premature discontinuation of effective biologics and point toward Janus kinase inhibitors, a 148-patient cohort suggests.

By
Andrea Surnit
June 15, 2026
4 min

MDSpire News

Objective:

To describe persistent, treatment-associated phenotype switching between psoriasis and atopic dermatitis and its implications.

Approach:

Study Design: A multinational retrospective cohort study involving 148 patients treated at 17 dermatology centers across multiple countries.
Patient Criteria: Patients had psoriasis or atopic dermatitis and developed a persistent switch to the opposing phenotype during systemic or biologic therapy.
Treatment Analysis: The study analyzed treatment modifications and clinical outcomes following recognition of phenotype switching.

Key Findings:

101 patients developed eczematous features while receiving treatment for psoriasis, primarily during interleukin-17 inhibitor therapy.
47 patients developed psoriasiform disease while receiving treatment for atopic dermatitis, with dupilumab accounting for 91.5% of these cases.
Switching from psoriasis to eczematous features was most common during interleukin-17 inhibitor treatment (58%).
Janus kinase inhibitors were the most frequently documented management strategy post-switch.

Interpretation:

The phenomenon of phenotype switching may be misinterpreted as treatment failure; recognizing it can guide appropriate therapeutic adjustments.

Limitations:

Retrospective observational design limits causal inference.
Lack of a comparator population and potential selection bias.
Incomplete data capture and absence of systematic histopathologic or molecular confirmation.
Predominantly Caucasian cohort may limit generalizability.