Eczematized psoriasis – a frequent but often neglected variant of plaque psoriasis

Abstract

Summary Psoriasis is a common chronic inflammatory skin disease that causes systemic inflammation and severely impacts the patient's quality of life. Several highly effective therapeutics for psoriasis have been approved in recent years. However, in real life, a high proportion of patients either do not experience the clinical improvement observed in clinical trials or develop a secondary loss of efficacy. This may be a result of unrecognized endotypes of psoriasis that need to be characterized in greater depth to enable selection of an appropriate therapy. Eczematized psoriasis, which occurs in approximately 5–10% of patients with psoriasis, is an often‐neglected variant of psoriasis. The term “eczematized psoriasis” refers to patients developing psoriasis with similarities to eczema. These patients typically present with severe itching, and skin biopsies often reveal eosinophil granulocytes, serum crusts, or spongiosis, which are frequently observed in eczema. From an immunological perspective, additional signaling pathways that are responsible for eczema reactions might be activated in eczematized psoriasis compared to classical plaque psoriasis. This review summarizes the key clinical, histological, and immunological features of eczematized psoriasis, proposes diagnostic criteria, and evaluates the therapeutic options for eczematized psoriasis.

Psoriazis hastalarında klasik/klasik olmayan histopatolojik bulguların psoriasis alt tiplerine, hastalık süresine ve şiddetine, anatomik bölgeye ve klinik görünüme göre değişimi

“…The most common findings in these patients were found to be spongiosis, the presence of eosinophils, and serum crusts. 41 Although spongiosis was a prominent histopathological finding in our study, eosinophils were not detected. Psoriasis, especially in the early stages, can manifest with minimal spongiosis in certain locations (e.g., mucosal and flexural involvement) and in the presence of severe eczema.…”

Current developments and perspectives in psoriasis

“…122 To address most of these challenges, proteogenomic approaches and molecular signatures will likely need to be expanded, implemented, and/or developed in conjunction with sophisticated immunologic-functional studies. 123,124 These will need to be supported by comprehensive "realworld" data, such as from registry studies and metaanalyses, to capture the actual full spectrum of psoriasis. Evaluations of large amounts of data from multiple sources (big data) will require evaluation supported by artificial intelligence algorithms.…”

Aktuelle Entwicklungen und Perspektiven bei Psoriasis

“…122 Um die meisten dieser Herausforderungen zu bewältigen, müssen wahrscheinlich proteogenomische Ansätze und molekulare Signaturen erweitert, umgesetzt und/oder in Verbindung mit anspruchsvollen immunologischfunktionellen Studien entwickelt werden. 123,124 Diese müssen durch umfassende Daten aus der "realen Welt", beispielsweise aus Registerstudien und Metaanalysen, unterstützt werden, um das tatsächliche gesamte Spektrum der Psoriasis zu erfassen. Auswertungen großer Datenmengen aus verschiedenen Quellen (Big Data) werden unterstützt von Algorithmen künstlicher Intelligenz ausgewertet werden müssen.…”