Telling apart psoriasis and eczema

July 9, 2014 § 1 Comment

Photo of a patient's skin who has psoriasis plaques in the center and eczema around the plaques. Photo courtesy of Kilian Eyerich.

Photo of a patient’s skin who has psoriasis plaques in the center and eczema around the plaques. Photo courtesy of Kilian Eyerich.

Eczema and psoriasis are chronic inflammatory skin diseases that sometimes are hard to tell apart because the irritated skin can look similar in both. Each condition requires a different kind of medical treatment. But when doctors can’t tell apart one condition from the other, it’s difficult for them to prescribe treatments, which can be expensive to undertake. Now, in a paper just out in the journal Science Translational Medicine, researchers have identified how the two conditions differ at the molecular level, which could guide clinicians in the future in telling the two skin diseases apart and prescribing treatment regimens.

Kilian and Stefanie Eyerich at the Technical University in Munich, Germany, know the frustrations of distinguishing between eczema and psoriasis firsthand.  “In our daily clinical practice, it is a common problem,” says Kilian Eyerich. “This is especially true for lesions on the hands, feet or scalp.”

The two investigators, who led the current study, noticed that some patients suffer from both psoriasis and eczema, with the manifestations of the two conditions sometimes appearing “just inches away from each other,” he says. He adds that this kind of patient is the “perfect model for us to investigate the pathogenesis of psoriasis and eczema” without the confounding factors of gender, age, genetics and environmental exposure.

The investigators recruited 24 patients who had both psoriasis and eczema and carried out polymerase chain reaction-based whole-genome expression analyses on unaffected skin, psoriasis lesions and eczema patches.

They found that psoriasis was mostly similar, on the molecular level, to a wound-healing reaction. The condition is known to be an immune response operating in overdrive in the outermost layer of the skin, causing scaly plaques. In contrast, eczema involved a different set of immune cells. These cells interfered with the epidermal barrier and the skin’s immune response. As a result, skin areas with eczema were susceptible to bacterial, fungal and viral infections, which inflame the skin even more.

Based on their results, the investigators zoomed in on two gene products, nitric oxide synthase 2 and the chemokine CCL27, which appeared to be specifically regulated in psoriasis. Eyerich says the expression levels of these two genes can help clinicians tell apart psoriasis and eczema. Indeed, in a different group of 53 patients, the investigators used these two genes to confirm diagnoses for some, provide new diagnoses and correct misdiagnoses.

Eyerich cautions that they need to reproduce their findings in larger groups of patients and use other molecular techniques, such as immunohistochemistry, to confirm their findings. But he hopes that the work will make an impact. “We hope this work will pave the way toward personalized medicine in inflammatory skin diseases,” he says. “We want to expand our investigation of the molecular signature of the diseases … to enable us to predict the perfect therapy for each individual patient based on his or her molecular signature in the future.”


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§ One Response to Telling apart psoriasis and eczema

  • I was covered with psoriasis from head to toe as a baby my mother said, and was found to be allergic to milk. They replaced the whole milk with goat’s milk and my mom said I improved. I only remember when I was 15 or 16 I had psoriasis in my scalp and maybe a small patch or two, I used tar shampoos then which seemed to give some relief, then for years my skin and head were clear. Then when I was about 38 I was drinking raw milk from a neighbor farmer and suddenly had a couple of bad patches on my legs. I stopped the milk and again my skin cleared for a good 10 years. With very little irritants, until now at 56, I had a total knee replacement 12/2013 and about 2 weeks after surgery I noticed patches around the same knee I had surgery on. Then It just went crazy, both legs are 40% covered, my arms, my back, torso, my scalp I feel even my eyes are affected, consistently watering and eye goop collecting on my lashes. My hair has thinned. It’s just been a real bad 6 months, I’ve been to my dermatologist several visits, tried all the creams, steroids available with no relief, and the itch is almost unbearable. I’ve also used coconut and olive oil whipped which seems to give a little help but overall this has been the very worst in all my 56 years. I’m back to my dermatologist tomorrow for a more aggressive treatment. All through my years I didn’t do anything special but stayed away from dairy products, but this time they told me it was a reaction from the surgery. I sure hope this clears soon as I’m to have a 2nd surgery on the same knee. Luck to me and to all you suffers of this dreadful skin disorder.

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