{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T10:17:27Z","timestamp":1787912247138,"version":"build-2784847793"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Clinical and genetic evidence on the association between atopic dermatitis (AD) and subsequent psoriasis remains conflicting, and it is unclear whether this risk is modified by systemic treatments. Recent reports suggest that type 2-targeted biologics may unmask psoriasis in patients with AD, but data are limited. We thus aimed to assess whether AD is associated with incident psoriasis and whether this risk differs by systemic treatment, particularly biologics versus conventional systemic immunosuppressants (cvIS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Scoping analyses informed a locked analytic design, preregistration at Open Science Framework, and confirmatory execution. Propensity score-matched analyses compared AD with non-AD controls and biologics with cvIS. Sensitivity analyses, including multivariable Cox proportional hazards (CPH) analyses, and control outcomes assessed robustness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among ~300,000 matched pairs, AD was associated with increased psoriasis risk [primary hazard ratio (HR) 3.81, 95% confidence interval (CI) 3.35\u20134.34], consistent across all eight sensitivity analyses and CPH. Biologic treatment was associated with reduced psoriasis risk versus cvIS (primary HR 0.20; 95% CI 0.11\u20130.35), consistent across eight of nine evaluable sensitivity analyses and CPH. Positive and negative control outcomes showed expected directional patterns.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Acknowledging limitations including residual confounding and coding misclassification, AD was associated with increased psoriasis risk and biologics with lower psoriasis risk than cvIS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1900942","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T09:41:53Z","timestamp":1787910113000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Incident psoriasis in atopic dermatitis: a large-scale cohort study of disease- and treatment-associated risks"],"prefix":"10.3389","volume":"17","author":[{"given":"Florian","family":"Thaqi","sequence":"first","affiliation":[{"name":"Luebeck Institute of Experimental Dermatology, University of Luebeck","place":["Luebeck, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katja","family":"Bieber","sequence":"additional","affiliation":[{"name":"Luebeck Institute of Experimental Dermatology, University of Luebeck","place":["Luebeck, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hatim","family":"Kerniss","sequence":"additional","affiliation":[{"name":"Luebeck Institute of Experimental Dermatology, University of Luebeck","place":["Luebeck, Germany"]},{"name":"Department of Cardiology, Goethe University Hospital","place":["Frankfurt am Main, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khalaf","family":"Kridin","sequence":"additional","affiliation":[{"name":"Luebeck Institute of Experimental Dermatology, University of Luebeck","place":["Luebeck, Germany"]},{"name":"Azrieli Faculty of Medicine, Bar-Ilan University","place":["Safed, Israel"]},{"name":"Unit of Dermatology and Skin Research Laboratory, Barch Padeh Medical Center","place":["Poriya, Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"Curman","sequence":"additional","affiliation":[{"name":"Luebeck Institute of Experimental Dermatology, University of Luebeck","place":["Luebeck, Germany"]},{"name":"Dermato-Venereology Clinic, Karolinska University Hospital","place":["Stockholm, Sweden"]},{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet","place":["Stockholm, Sweden"]},{"name":"Dermatology and Venereology Division, Department of Medicine (Solna), Karolinska Institutet","place":["Stockholm, Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralf J.","family":"Ludwig","sequence":"additional","affiliation":[{"name":"Luebeck Institute of Experimental Dermatology, University of Luebeck","place":["Luebeck, Germany"]},{"name":"Institute and Comprehensive Center for Inflammation Medicine, University of Luebeck","place":["Luebeck, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)32549-6","article-title":"Psoriasis","volume":"397","author":"Griffiths","year":"2021","journal-title":"Lancet"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(24)02519-4","article-title":"Atopic dermatitis","volume":"405","author":"Guttman-Yassky","year":"2025","journal-title":"Lancet Lond Engl"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1104200","article-title":"Mutual antagonism of T cells causing psoriasis and atopic eczema","volume":"365","author":"Eyerich","year":"2011","journal-title":"N Engl J Med"},{"key":"B4","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1016\/j.coi.2017.08.008","article-title":"Atopic dermatitis and psoriasis: two different immune diseases or one spectrum","volume":"48","author":"Guttman-Yassky","year":"2017","journal-title":"Curr Opin Immunol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2015.2","article-title":"Immunologic overlap of helper T-cell subtypes 17 and 22 in erythrodermic psoriasis and atopic dermatitis","volume":"151","author":"Moy","year":"2015","journal-title":"JAMA Dermatol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1111\/joim.13235","article-title":"So close, and yet so far away: The dichotomy of the specific immune response and inflammation in psoriasis and atopic dermatitis","volume":"290","author":"Sch\u00e4bitz","year":"2021","journal-title":"J Intern Med"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1159\/000514581","article-title":"Bidirectional association between psoriasis and atopic dermatitis: a nationwide population-based cohort study","volume":"237","author":"Dai","year":"2021","journal-title":"Dermatology"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2022.03.030","article-title":"Atopic dermatitis and risk of autoimmune conditions: population-based cohort study","volume":"150","author":"de Lusignan","year":"2022","journal-title":"J Allergy Clin Immunol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1684\/ejd.2021.3963","article-title":"Incidence of atopic conditions in people with psoriasis: a population-based analysis","volume":"31","author":"Kirsten","year":"2021","journal-title":"Eur J Dermatol EJD"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0322602","article-title":"Causal associations between psoriasis and atopic dermatitis: a bidirectional Mendelian randomization study","volume":"20","author":"Wang","year":"2025","journal-title":"PloS One"},{"key":"B11","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1007\/s00403-024-02978-2","article-title":"Association between allergic diseases and both psoriasis and psoriatic arthritis: a bidirectional 2-sample Mendelian randomization study","volume":"316","author":"Zhao","year":"2024","journal-title":"Arch Dermatol Res"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajhg.2014.12.004","article-title":"Genome-wide comparative analysis of atopic dermatitis and psoriasis gives insight into opposing genetic mechanisms","volume":"96","author":"Baurecht","year":"2015","journal-title":"Am J Hum Genet"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12196291","article-title":"\u2018De novo\u2019 psoriasis and relapse of psoriasis induced by dupilumab: three new cases and review of the literature","volume":"12","author":"Trave","year":"2023","journal-title":"J Clin Med"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1093\/ced\/llaf483","article-title":"Psoriasis and seronegative spondyloarthropathy in patients with atopic dermatitis treated with dupilumab or tralokinumab: a multicentre observational study","volume":"51","author":"Lauletta","year":"2026","journal-title":"Clin Exp Dermatol"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdcr.2018.05.014","article-title":"Erythrodermic presentation of psoriasis in a patient treated with dupilumab","volume":"4","author":"Tracey","year":"2018","journal-title":"JAAD Case Rep"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2025.1578","article-title":"Psoriasis risk in patients with atopic dermatitis treated with dupilumab","volume":"161","author":"Lin","year":"2025","journal-title":"JAMA Dermatol"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2024.111341","article-title":"The majority of observational studies in leading peer-reviewed medicine journals are not registered and do not have a publicly accessible protocol: a scoping review","volume":"170","author":"Leducq","year":"2024","journal-title":"J Clin Epidemiol"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2025.1516126","article-title":"A comprehensive review of methodologies and application to use the real-world data and analytics platform TriNetX","volume":"16","author":"Ludwig","year":"2025","journal-title":"Front Pharmacol"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1002\/pds.70198","article-title":"TriNetX Dataworks\u2010USA: overview of a multi\u2010purpose, de\u2010identified, federated electronic health record real\u2010world data and analytics network and comparison to the US Census","volume":"34","author":"Stein","year":"2025","journal-title":"Pharmacoepidemiol Drug Saf"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1093\/jamiaopen\/ooad035","article-title":"A global federated real-world data and analytics platform for research","volume":"6","author":"Palchuk","year":"2023","journal-title":"JAMIA Open"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001885","article-title":"The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement","volume":"12","author":"Benchimol","year":"2015","journal-title":"PloS Med"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.k3532","article-title":"The reporting of studies conducted using observational routinely collected health data statement for pharmacoepidemiology (RECORD-PE)","volume":"363","author":"Langan","year":"2018","journal-title":"BMJ"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.7326\/M16-2607","article-title":"Sensitivity analysis in observational research: introducing the E-value","volume":"167","author":"VanderWeele","year":"2017","journal-title":"Ann Intern Med"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2025.1702736","article-title":"Dupilumab treatment is not associated with changes in lymphoma risk in atopic dermatitis and other type 2 inflammatory diseases: data from a large-scale retrospective cohort study","volume":"12","author":"Kridin","year":"2025","journal-title":"Front Med"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1016\/j.jid.2026.05.012","article-title":"Understanding the atopic dermatitis-psoriasis phenotypic switch through a pharmacovigilance-based approach","author":"Yang","year":"2026","journal-title":"J Invest Dermatol"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2009.07.029","article-title":"Incidence of psoriasis in children: a population-based study","volume":"62","author":"Tollefson","year":"2010","journal-title":"J Am Acad Dermatol"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1001\/jamadermatol.2021.2007","article-title":"Psoriasis prevalence in adults in the United States","volume":"157","author":"Armstrong","year":"2021","journal-title":"JAMA Dermatol"},{"key":"B28","doi-asserted-by":"publisher","first-page":"394","DOI":"10.1016\/j.jaad.2008.10.062","article-title":"Trends in incidence of adult-onset psoriasis over three decades: a population-based study","volume":"60","author":"Icen","year":"2009","journal-title":"J Am Acad Dermatol"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1002\/art.42942","article-title":"Genetically proxied interleukin-13 inhibition is associated with risk of psoriatic disease: a Mendelian randomization study","volume":"76","author":"Zhao","year":"2024","journal-title":"Arthritis Rheumatol"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.e7325","article-title":"Use of Mendelian randomisation to assess potential benefit of clinical intervention","volume":"345","author":"Burgess","year":"2012","journal-title":"BMJ"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1900942\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T09:41:55Z","timestamp":1787910115000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1900942\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,28]]},"references-count":30,"alternative-id":["10.3389\/fimmu.2026.1900942"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2026.1900942","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,28]]},"article-number":"1900942"}}