Diagnostic and Therapeutic Challenges in Psoriasis-Atopic Dermatitis Overlap: A Retrospective Observational Cohort Study

Abstract

Background and Objectives: Psoriasis and atopic dermatitis (AD) are immune-mediated inflammatory diseases traditionally viewed as distinct. However, a subset of patients may present with overlapping features, leading to diagnostic and therapeutic challenges. This study aims to characterize the clinical, histopathological, and therapeutic features of patients with psoriasis-AD overlap. Materials and Methods: A retrospective review was conducted on patients diagnosed with both psoriasis vulgaris and AD between January 2021 and October 2024 at a single tertiary dermatology center. Inclusion required histopathological confirmation of psoriasis and a clinical diagnosis of AD based on Hanifin and Rajka criteria. Clinical features, histopathology, treatment history, and 6-month outcomes were analyzed. Results: Out of 469 patients screened, 24 (5.1%) had both conditions. Psoriasis preceded AD in 91.6% of cases. Most patients had intrinsic AD subtypes and moderate-to-severe diseases. Palmoplantar involvement was present in 66.6%, often refractory to biologics alone. Histological overlap complicated diagnosis, with repeated biopsies required in 58.3% of cases. Patients with dual diseases often required combination therapy, and JAK inhibitors showed favorable outcomes in refractory cases. Conclusions: Psoriasis-AD overlap represents a distinct clinical entity requiring individualized diagnosis and management. Recognition of this phenotype is critical for optimizing therapeutic outcomes.

Keywords: atopic dermatitis; overlap; psoriasis.

Figure 1

Illustration of the overlapping and distinct clinical and immunological features of psoriasis and AD. The diagram highlights common immune pathways (Th17/Th22) and distinct therapeutic implications.