{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T19:16:47Z","timestamp":1788808607965,"version":"build-2803163510"},"reference-count":16,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acad Dermatol Venereol"],"abstract":"Abstract<\/jats:title>\n \n \n Psoriasis and atopic dermatitis (AD) are traditionally viewed as distinct inflammatory skin diseases driven by type 17 and type 2 immune pathways, respectively. Increasing use of targeted therapies has revealed a treatment\u2010associated phenotype switch between these conditions, the so\u2010called \u2018flip\u2010flop\u2019 phenomenon, characterized by sustained emergence of eczematous features in patients treated for psoriasis or psoriasiform disease in those treated for AD. Robust real\u2010world data on this entity remain limited.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n To characterize treatment\u2010associated phenotype switching between psoriasis and AD in a large real\u2010world cohort, focusing on clinical features, implicated therapies, management strategies and outcomes.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We conducted a retrospective, multicentre, multinational observational study across 17 dermatology centres in six countries. Patients with psoriasis or AD who developed a clinician\u2010defined, persistent phenotype switch temporally associated with systemic or biologic therapy and requiring treatment modification were included. Demographic, clinical, therapeutic and outcome data were collected and analysed descriptively.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 148 patients were included: 101 (68.2%) developed eczematous features while treated for psoriasis (PsO\u2009\u2192\u2009eczematous), and 47 (31.8%) developed psoriasiform disease while treated for AD (AD\u2009\u2192\u2009psoriasiform). PsO\u2009\u2192\u2009eczematous patients were older and had more cardiometabolic comorbidities, whereas atopic comorbidities were more frequent in the AD\u2009\u2192\u2009psoriasiform group. PsO\u2009\u2192\u2009eczematous switches occurred mainly under interleukin (IL)\u201017 and IL\u201023 inhibitors, while AD\u2009\u2192\u2009psoriasiform switches occurred exclusively during biologic therapies targeting type 2 inflammation, predominantly dupilumab. Treatment was modified in all patients. Janus kinase (JAK) inhibitors were the most frequently used strategy in both switch directions, particularly in PsO\u2009\u2192\u2009eczematous cases. Marked clinical improvement was observed across phenotypes following therapeutic adjustment.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Treatment\u2010associated phenotype switching between psoriasis and AD is a reproducible, bidirectional and clinically relevant real\u2010world phenomenon reflecting immune plasticity rather than paradoxical disease induction. Recognition of this entity is essential to guide appropriate therapeutic adaptation, with JAK inhibitors emerging as a commonly effective management option.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/jdv.70503","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T09:53:56Z","timestamp":1778752436000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Treatment\u2010associated phenotype switching between psoriasis and atopic dermatitis"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0404-0870","authenticated-orcid":false,"given":"Tiago","family":"Torres","sequence":"first","affiliation":[{"name":"Department of Dermatology Centro Acad\u00e9mico Cl\u00ednico ICBAS\/Santo Ant\u00f3nio Porto Portugal"},{"name":"Instituto de Ci\u00eancias Biom\u00e9dicas Abel Salazar University of Porto Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Valenti","sequence":"additional","affiliation":[{"name":"Dermatology Unit IRCCS Humanitas Research Hospital Milan Italy"},{"name":"Department of Biomedical Sciences Humanitas University Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5485-0172","authenticated-orcid":false,"given":"Anna","family":"Balato","sequence":"additional","affiliation":[{"name":"Unit of Dermatology University of Campania Luigi Vanvitelli Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Megna","sequence":"additional","affiliation":[{"name":"Section of Dermatology, Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1777-9001","authenticated-orcid":false,"given":"Paolo","family":"Gisondi","sequence":"additional","affiliation":[{"name":"Department of Dermatology University of Verona Verona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vimal","family":"Prajapati","sequence":"additional","affiliation":[{"name":"Division of Dermatology, Department of Medicine University of Calgary Calgary Canada"},{"name":"Section of Community Pediatrics and Pediatric Rheumatology, Department of Pediatrics University of Calgary Calgary Canada"},{"name":"Skin Health & Wellness Centre Calgary Canada"},{"name":"Probity Medical Research Calgary Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Piaserico","sequence":"additional","affiliation":[{"name":"Department of Dermatology University of Padua Padua Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9914-1545","authenticated-orcid":false,"given":"Julia\u2010Tatjana","family":"Maul","sequence":"additional","affiliation":[{"name":"Department of Dermatology University Hospital Z\u00fcrich Z\u00fcrich Switzerland"},{"name":"Faculty of Medicine University of Z\u00fcrich Z\u00fcrich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lara Valeska","family":"Maul","sequence":"additional","affiliation":[{"name":"Department of Dermatology University Hospital Z\u00fcrich Z\u00fcrich Switzerland"},{"name":"Faculty of Medicine University of Z\u00fcrich Z\u00fcrich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4266-0771","authenticated-orcid":false,"given":"Jose Manuel","family":"Carrascosa","sequence":"additional","affiliation":[{"name":"Servicio de Dermatolog\u00eda Hospital Universitari Germans Trias i Pujol, IGTP, UAB Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5454-3671","authenticated-orcid":false,"given":"Francisco Jos\u00e9","family":"Navarro\u2010Trivi\u00f1o","sequence":"additional","affiliation":[{"name":"Cutaneous Immunoallergy Unit, Dermatology Department San Cecilio University Hospital Granada Spain"},{"name":"Institute for Biomedical Research IBS Granada Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Lazaridou","sequence":"additional","affiliation":[{"name":"Second Department of Dermatology\u2010Venereology Aristotle University School of Medicine Thessaloniki Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u00e9sar","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Department of Dermatology Centro Acad\u00e9mico Cl\u00ednico ICBAS\/Santo Ant\u00f3nio Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacopo","family":"Tartaglia","sequence":"additional","affiliation":[{"name":"Department of Dermatology University of Padua Padua Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Ciolfi","sequence":"additional","affiliation":[{"name":"Department of Dermatology University of Padua Padua Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Athina\u2010Ioanna","family":"Daponte","sequence":"additional","affiliation":[{"name":"Second Department of Dermatology\u2010Venereology Aristotle University School of Medicine Thessaloniki Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugenia Veronica Di","family":"Brizzi","sequence":"additional","affiliation":[{"name":"Unit of Dermatology University of Campania Luigi Vanvitelli Naples 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Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Ferruci","sequence":"additional","affiliation":[{"name":"Dermatology Unit Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy"},{"name":"Department of Pathophysiology and Transplantation Universit\u00e0 Degli Studi di Milano Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Prignano","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Section of Dermatology University of Florence Florence Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0676-1260","authenticated-orcid":false,"given":"Esteban","family":"Dauden","sequence":"additional","affiliation":[{"name":"Department of Dermatology Hospital Universitario de La Princesa Instituto de Investigaci\u00f3n Sanitaria de La Princesa (IIS\u2010IP) Madrid 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