Genomic Profiling of the Overlap Phenotype between Psoriasis and Atopic Dermatitis

Clinical overlaps between psoriasis and atopic dermatitis are sometimes undiscernible, and there is no consensus whether to treat the overlap phenotype as psoriasis or atopic dermatitis. We enrolled 41 patients diagnosed with either psoriasis or atopic dermatitis, and clinically re-stratified them into classic psoriasis (n =11), classic atopic dermatitis (n =13), and the overlap phenotype between psoriasis and atopic dermatitis (n=17). We compared gene expression profiles of lesional and nonlesional skin biopsy tissues and proteomic profiles of blood samples between the three comparison groups. Global mRNA expression and T-cell subset cytokine expression in the skin and protein biomarker elevation in the blood of the overlap phenotype were consistent with the profiles of psoriasis and different from the profiles of atopic dermatitis. Unsupervised k-means clustering indicated that the best number of distinct clusters for the total population of the three comparison groups was two, and the two clusters of psoriasis and atopic dermatitis were differentiated by gene expression. Our study suggests that clinical overlap phenotype between psoriasis and atopic dermatitis has dominant molecular features of psoriasis, and genomic biomarkers can differentiate psoriasis and atopic dermatitis at molecular levels in patients with a spectrum of psoriasis and atopic dermatitis.