Eczema-Psoriasis Overlap: An eDelphi Consensus on Clinical Presentation and Therapeutic Management Among Italian...

Atopic dermatitis and psoriasis (PsO) are common chronic inflammatory skin diseases traditionally considered distinct, driven by Th2 and Th1/Th17 pathways, respectively. However, evidence reveals that some patients may present with both eczematous and psoriatic lesions, either simultaneously or sequentially. This study's objective was to establish an Italian consensus on the clinical definition and management of eczema-psoriasis overlap.

A steering committee of eight dermatologists identified three key areas: problem definition, clinical presentation and therapeutic management. Forty-three statements were drafted and distributed to 131 dermatologists for evaluation via an eDelphi process, using a 1-9 numeric rating scale. Consensus was defined as a mean score ≥ 7.

Of the 131 invited participants, 104 responded (79.4%). Consensus was reached for 42/43 statements. The only statement that failed to achieve consensus concerned the influence of respiratory atopic comorbidities on biologic choice in PsO; as a result of its dichotomous nature, it was not revised or re-voted on.

Eczema and PsO exist on a continuum of immune dysregulation, which may manifest sequentially or concomitantly, with phenotypic switches that can be spontaneous or drug induced. Assessment of risk factors for drug-induced forms should guide therapeutic choices. Mild cases can often be managed with topical therapies, while moderate-to-severe forms may require broader T cell-targeting treatments.