The neglected twin:
nummular eczema is a variant of atopic dermatitis with co-dominant Th2/Th17 immune response.
J Allergy Clin Immunol 2023:S0091-6749(23)00514-6. [PMID:
37119871 DOI:
10.1016/j.jaci.2023.04.009]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/23/2023] [Accepted: 04/07/2023] [Indexed: 05/01/2023]
Abstract
BACKGROUND
Nummular eczema (NE) is a common chronic inflammatory skin disease characterized by multiple, pruritic, discoid-shaped lesions. Since the underlying immune mechanisms are not fully understood, it is unclear whether NE should be regarded as variant of atopic dermatitis (AD) or a distinct disease.
OBJECTIVE
Here, we compared the clinical, histopathological, and molecular signature of NE with that of type 2 and type 3 skin diseases.
METHODS
We performed bulk RNAseq, histological and clinical studies in lesional and non-lesional skin biopsy specimens from NE (n=50), AD (n=47) and psoriasis (n=90) patients.
RESULTS
NE displayed typical hallmarks of AD such as an impaired epidermal barrier, microbial colonization, spongiosis and eosinophil infiltration, but also aspects of psoriasis including increased epidermal thickness, number of Ki67+ cells and neutrophilic infiltration. On gene expression level, neutrophil-attracting cytokines (IL19, CXCL8, CXCL5) were upregulated while Th2-related cytokines (IL13, CCL17, CCL18, CCL26, CCL27) were similar expressed in NE compared to AD. Principal component analysis of transcriptome data from lesional skin showed that AD and NE cluster together distinct of psoriasis. In line with this, an established molecular classifier identified NE as AD rather than psoriasis. Finally, we demonstrated clinical and molecular efficacy of Dupilumab treatment in NE.
CONCLUSION
In summary, NE shows overlapping type 2 and type 3 immune signatures, while type 2 immunity is dominating and should be the primary target of specific therapeutic interventions. This supports the view of NE as a variant of AD.
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