|Year : 2014 | Volume
| Issue : 4 | Page : 280-282
Atopic dermatitis and psoriasis vulgaris occurring in same families
Rajyalaxmi Konathan, A Sainath Kumar
Department of Dermatology, Central Hospital, Lallaguda, South Central Railway, Secunderabad, Andhra Pradesh, India
|Date of Web Publication||10-Dec-2014|
2-17-28, S.B.H. Colony, Uppal Kalan, Uppal, Hyderabad - 500 039, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
Psoriasis and atopic dermatitis (AD) are chronic and relapsing inflammatory diseases of the skin associated with various immunologic abnormalities. Psoriasis is driven by type 1 helper T and type 17 helper T cells, while AD is driven by type 2 helper T cells. Simultaneous occurrence of psoriasis vulgaris and AD in same families is not very rare but commonly missed entity. We are reporting nine cases of AD and psoriasis vulgaris occurring in same families.
Keywords: Atopic dermatitis, families, psoriasis vulgaris
|How to cite this article:|
Konathan R, Kumar A S. Atopic dermatitis and psoriasis vulgaris occurring in same families. J NTR Univ Health Sci 2014;3:280-2
| Introduction|| |
Psoriasis vulgaris and atopic dermatitis (AD) are two common chronic inflammatory skin diseases, characterized by various different clinical and histological features depending on the stage of the disease. Although both diseases are generally regarded as immune-mediated conditions, recent genetic studies have indicated the importance of abnormalities in epithelium-expressed genes as a primary cause.  Though the occurrence of both the conditions in same patients and families are probably common, but sparsely reported in the literature. Hence, we are reporting nine cases with AD and psoriasis vulgaris seen in families.
| Case report|| |
Patients attending to Department of Dermatology were screened for psoriasis vulgaris and AD. Detailed family history was obtained, and then diagnosed as psoriasis vulgaris and AD clinically and histopathologically. Hence, a total of 9 cases were detected having AD and psoriasis vulgaris with significant positive family history of both in few and at least one of the two conditions in others. The details of the patients are tabulated in [Table 1]. [Figure 1], [Figure 2] and [Figure 3] are the clinical photographs.
|Figure 1: Atopic dermatitis and psoriasis vulgaris seen in a female patient|
Click here to view
|Figure 2: Atopic dermatitis and psoriasis vulgaris seen in a male patient|
Click here to view
|Figure 3: Atopic dermatitis seen in siblings showing lesions over cubital fossa and foot|
Click here to view
| Discussion|| |
Psoriasis is generally regarded as a disease dominated by type 1 helper T (Th1) cytokines, whereas AD, particularly in active lesions, is driven by type 2 helper T (Th2) cytokines. Genome-wide linkage scans have identified multiple loci linked to each disease and revealed overlap with psoriasis and AD susceptibility loci on chromosomes 1q21, 3q21, 17q25, and 20p12. Genes implicated so far in AD are SPINK5, FceRI-b, and PHF11. The peak of linkage of eczema and psoriasis on chromosome 1q21 overlies the human epidermal differentiation complex (EDC) that spans a region of ~2 mb. The genes of the EDC are expressed late during maturation of epidermal cells. Genetic studies of both psoriasis and AD suggest that defects affecting cells of the skin need to be as seriously considered as defects in adaptive immunity. 
Psoriasis and AD are chronic and relapsing inflammatory diseases of the skin associated with various immunologic abnormalities.  Family clustering of the disease is well-established, and nonparametric linkage analyses have mapped disease susceptibility loci on chromosomes 6p (PSORS1) and 17q (PSORS2) and additional susceptibility locus on chromosome 1q21 (PSORS4).  The telomere length was significantly reduced in all T cell subsets from both AD and psoriasis patients compared with normal individuals. The increased telomerase activity and shortened telomere length indicates that T lymphocytes in AD and psoriasis are chronically stimulated and have increased cellular turnover in vivo. The shortening of telomeres is likely to reflect the increased cell proliferation, which would support the view that the affected T cells have gone through a large number of cell divisions because of chronic stimulation in vivo.  The simultaneous occurrence of psoriasis driven by Th1 cells and type 17 helper T (Th17) cells and atopic eczema dominated by Th2 cells is rare. Stefanie Eyerich et al. described three patients with co-occurring psoriasis and atopic eczema with an antagonistic course and distinct T-cell infiltrates in lesions from psoriasis and those from atopic eczema.  On the basis of incidence rates for both diseases in Enno Christopher's (retrospective study 1953-1983) study, 36 (0.14%) out of 29,159 patients with both psoriasis and atopic eczema were expected to be seen, but both conditions were seen simultaneously present only in two patients.  In the study (1955-1992) data from 42,461 patients were compiled by Tilo Hanseler, AD and psoriasis were seen in five cases that are 25 times less frequently associated with psoriasis than expected. Both psoriasis and AD demonstrate the functional dichotomy of human T-cell subsets resulting in contrasting clinical diseases.  In one study, history of atopy in the patients and his relatives was elicited in 356 unselected cases of psoriasis and compared with 1000 randomly collected patients having other diseases. The study showed a negative and the personal history of atopy.  Abramovits et al. found that 20% could be diagnosed as "intermediate" having lesions with characteristics of both psoriasis and eczema, or a personal history of both. The authors suggest naming this category of inflammatory dermatosis "PsEma": An overlap condition in which the clinical, histologic, molecular, biologic and therapeutic responses show characteristics of both psoriasis and eczema.  Kapila et al. found that psoriasis and psoriasis-dermatitis overlap in children both differ clinically from AD and have identified historical and clinical features that characterize childhood psoriasis. 
| Conclusion|| |
Though the occurrence of both the conditions in same patients and families are probably common, but sparsely reported in the literature and also most frequently missed entity. It affects the therapy and prognosis. Systemic steroids cannot be given to the patients who have both as it aggravates psoriasis and precipitates pustular psoriasis, whereas steroids are drug of choice in AD. Hence, methotrexate and other immunomodulators will work on both the conditions. If one is aware of the association management will be appropriate.
| References|| |
Zeeuwen PL, de Jongh GJ, Rodijk-Olthuis D, Kamsteeg M, Verhoosel RM, van Rossum MM, et al.
Genetically programmed differences in epidermal host defense between psoriasis and atopic dermatitis patients. PLoS One 2008;3:e2301.
Bowcock AM, Cookson WO. The genetics of psoriasis, psoriatic arthritis and atopic dermatitis. Hum Mol Genet 2004;1:R43-55.
Capon F, Semprini S, Chimenti S, Fabrizi G, Zambruno G, Murgia S, et al.
Fine mapping of the PSORS4 psoriasis susceptibility region on chromosome 1q21. J Invest Dermatol 2001;116:728-30.
Wu K, Higashi N, Hansen ER, Lund M, Bang K, Thestrup-Pedersen K. Telomerase activity is increased and telomere length shortened in T cells from blood of patients with atopic dermatitis and psoriasis. J Immunol 2000;165:4742-7.
Eyerich S, Onken AT, Weidinger S, Franke A, Nasorri F, Pennino D, et al.
Mutual antagonism of T cells causing psoriasis and atopic eczema. N Engl J Med 2011;365:231-8.
Christophers E, Henseler T. Contrasting disease patterns in psoriasis and atopic dermatitis. Arch Dermatol Res 1987;279 Suppl:S48-51.
Henseler T, Christophers E. Disease concomitance in psoriasis. J Am Acad Dermatol 1995;32:982-6.
Kaur P, Singh G, Singh RK. Psoriasis and atopy. Indian J Dermatol Venereol Leprol 1985;51:160-1.
Abramovits W, Cockerell C, Stevenson LC, Goldstein AM, Ehrig T, Menter A. PsEma - a hitherto unnamed dermatologic entity with clinical features of both psoriasis and eczema. Skinmed 2005;4:275-81.
Kapila S, Hong E, Fischer G. A comparative study of childhood psoriasis and atopic dermatitis and greater understanding of the overlapping condition, psoriasis-dermatitis. Australas J Dermatol 2012;53:98-105.
[Figure 1], [Figure 2], [Figure 3]