A distinct psoriasis–atopic dermatitis overlapping phenotype in adults with dual type 2 and type 3 immune features and favorable response to Janus kinase 1 inhibition - 12/06/26

Doi : 10.1016/j.jaad.2026.05.042

Mengjiao Chen, MD ^a,^b, Chen Shen, MD ^a,^b, Chun-Bing Chen, MD, PhD ^c,^d,^e,^f,^g,^h, Yeqiang Liu, MD, PhD ⁱ, Yu-Huei Huang, MD, PhD ^c,^f, Chun-Wei Lu, MD, PhD ^c,^d,^e,^f,^g, Rosaline Chung-Yee Hui, MD, PhD ^c,^f, Chih-Yu Su, MS ^c, Chuang-Wei Wang, PhD ^c,^d,^e,^j,^⁎ , Wen-Hung Chung, MD, PhD ^c,^d,^e,^f,^g,^h,^k,^⁎ , Juan Tao, MD, PhD ^a,^b,^⁎

^a Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

^b Hubei Engineering Research Center of Skin Disease Theranostics and Health, Huazhong University of Science and Technology, Wuhan, China

^c Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taipei, and Keelung, Taiwan

^d Chang Gung Immunology Consortium, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan

^e Department of Dermatology, Xiamen Chang Gung Hospital, Xiamen, China

^f College of Medicine, Chang Gung University, Taoyuan, Taiwan

^g Immune-Oncology Center of Excellence, Chang Gung Memorial Hospital, Linkou, Taiwan

^h Whole-Genome Research Core Laboratory of Human Diseases, Chang Gung Memorial Hospital, Keelung, Taiwan

ⁱ Department of Dermatopathology, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China

^j Department of Physiology and Pharmacology, College of Medicine, Chang Gung University, Taoyuan, Taiwan

^k Genomic Medicine Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taiwan

^∗ Correspondence to: Juan Tao, Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Ave, Wuhan, Hubei, China. Department of Dermatology Union Hospital Tongji Medical College, Huazhong University of Science and Technology No. 1277 Jiefang Ave Wuhan Hubei China ^∗∗ Wen-Hung Chung, Department of Dermatology, Chang Gung Memorial Hospital, Linkou, No. 5, Fusing Street, Taoyuan City 333, Taiwan. Department of Dermatology Chang Gung Memorial Hospital Linkou No. 5 Fusing Street Taoyuan City 333 Taiwan ^∗∗∗ Chuang-Wei Wang, Chang Gung Immunology Consortium, Chang Gung Memorial Hospital and Chang Gung University, No. 5, Fuxing Street, Gongxi Village, Guishan District, Taoyuan City 333, Taiwan. Chang Gung Immunology Consortium Chang Gung Memorial Hospital and Chang Gung University No. 5, Fuxing Street Gongxi Village Guishan District Taoyuan City 333 Taiwan

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Friday 12 June 2026

Abstract

Background

Patients exhibiting overlapping histopathologic features of psoriasis (Pso) and atopic dermatitis (AD) present a diagnostic and therapeutic challenge.

Objectives

To delineate the clinicopathological and immunologic portrait of psoriasis–atopic dermatitis overlapping (Pso-Ec) for integrated diagnosis and therapeutic decision-making.

Methods

We conducted a 2-center prospective study comparing 30 Pso-Ec patients with typical Pso and AD cohorts. Clinicopathological characteristics and immunologic profiling of lesional skin and peripheral blood were analyzed, and treatment courses were assessed.

Results

Pso-Ec patients (aged 13-72 years; mean age: 49.7 years) presented with ill-defined erythematous plaques with thin scales, excoriation, intense itching, and mixed psoriatic-eczematous histology. Immune profiling showed co-existence of helper T cell 2/cytotoxic T cell 2 and helper T cell 17/cytotoxic T cell 17 in skin and blood, with Janus kinase (JAK) 1 signal transducer and activator of transcription 2/6 signaling involvement. Responses to prior Pso-targeted (n = 18) and AD-targeted (n = 15) biologics were often inadequate. In contrast, JAK1 inhibitors achieved minimal disease activity (body surface area ≤ 2, numerical rating scale ≤1) during a median follow-up of 17 months. No progression to classic Pso or AD phenotypes was observed.

Limitations

Sample size was limited and immunologic analyses were performed in a representative subset of patients.

Conclusions

Pso-Ec represents a distinct, predominantly adult-onset phenotype driven by dual type 2 and type 3 inflammation, and JAK1 inhibitors appear as an effective option.

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Key words : adult-predominant, atopic dermatitis, JAK1 inhibitor, overlapping phenotype, psoriasis, type 2 and type 3 inflammation

Abbreviations used : AD, FFPE, HD, IL, JAK, NRS, PBMC, PD, pJAK, Pso, Pso-Ec, qod, STAT, Tc, Th

Plan

Introduction

Methods

Patient inclusion criteria, sample collection, and study approval

Histopathological and multicolor immunofluorescence evaluation

Flow cytometry

NanoString RNA sequencing

Statistical analysis

Results

Clinical and histopathological characteristics of Pso-Ec patients

Dual type 2 and type 3 inflammation and genetic susceptibility

JAK-STAT activation in Pso-Ec patients

Biologic and JAK1 inhibitor responses in Pso-Ec patients

Discussion

Conclusion

Declaration of generative AI and AI-assisted technologies in the writing process

	Authors Chen and Shen contribute equally to this work.
	Funding sources: This study was supported by the National Natural Science Foundation of China , China (grant no. U24A20703 , 82130089 ), the Natural Science Foundation of Hubei Province , China (grant no. 2023AFB1024 ), the National Science and Technology Council , Taiwan (grant no. NSTC 113-2320B-182A-003-MY3 , 113-2326B-182A-001 , 114-2811B-182A-010 , 114-2628B-182A-003-MY3 ), and Chang Gung Memorial Hospital , Taiwan (grant no. CIRPG3M0101-3 ).
	Patient consent: Written consent for the publication of recognizable patient photographs or other identifiable material was obtained by the authors and attested to at the time of article submission to the journal stating that all patients gave consent with the understanding that this information may be publicly available. In addition, all patients from whom biological samples were collected provided written informed consent for sample collection and use.
	IRB approval status: Reviewed and approved by the institutional review boards and the ethics committee of Union Hospital, Tongji Medical College (IRB no. [2020]0575-01, [2025]0022) and Chang Gung Memorial Hospital (IRB no. 202200187A3, 202200283B0, 201902171A3, 202402204A3, 202402068B0).