Annals of the Russian academy of medical sciencesAnnals of the Russian academy of medical sciencesВестник Российской академии медицинских наук0869-60472414-3545"Paediatrician" Publishers LLC996510.15690/vramn9965PEDIATRICS: CURRENT ISSUESАКТУАЛЬНЫЕ ВОПРОСЫ ПЕДИАТРИИResearch ArticleControversial Issues of Immunopathogenesis of Psoriasis and Atopic DermatitisДискуссионные вопросы иммунопатогенеза псориаза и атопического дерматитаhttps://orcid.org/0000-0002-8232-8936AmbarchianEduard T.АмбарчянЭдуард Тигранович
Russian Federation

MD, PhD

к.м.н.

edo_amb@mail.ruhttps://orcid.org/0000-0002-2209-7531Namazova-BaranovaLeila S.Намазова-БарановаЛейла Сеймуровна
Russian Federation

MD, PhD, Professor, Academician of the RAS

д.м.н., профессор, академик РАН

leyla.s.namazova@gmail.comhttps://orcid.org/0000-0003-3003-9398KuzminovaAnastasiia D.КузьминоваАнастасия Дмитриевна
Russian Federation

MD

врач-дерматолог

kuzminova_derma@mail.ruhttps://orcid.org/0000-0002-6760-3119IvanchikovVladislav V.ИванчиковВладислав Владимирович
Russian Federation

MD

врач-дерматолог

awdawd22@yandex.ruhttps://orcid.org/0000-0001-7398-0562VishnevaElena A.ВишнёваЕлена Александровна
Russian Federation

MD, PhD, Professor of the RAS

д.м.н., профессор РАН

vishneva.e@yandex.ruhttps://orcid.org/0000-0002-4669-9510IvardavaMarika I.ИвардаваМарика Индикоевна
Russian Federation

MD, Phd

к.м.н.

makussa@mail.ruhttps://orcid.org/0000-0003-0317-2425EfendiyevaKamilla E.ЭфендиеваКамилла Евгеньевна
Russian Federation

MD, PhD, Associate Professor

к.м.н., доцент

kamillaef@inbox.ruhttps://orcid.org/0000-0002-2460-7718LevinaJuliya G.ЛевинаЮлия Григорьевна
Russian Federation

MD, PhD, Associate Professor

д.м.н., доцент

julia.levina@mail.ruPediatrics and Child Health Research Institute in Petrovsky National Research Centre of SurgeryНИИ педиатрии и охраны здоровья детей Научно-клинического центра № 2 ФГБНУ «РНЦХ им. акад. Б.В. Петровского»Pirogov Russian National Research Medical University (Pirogov Medical University)Российский национальный исследовательский медицинский университет имени Н.И. Пирогова231220237865825880305202301122023Copyright ©; 2023, "Paediatrician" Publishers LLCCopyright ©; 2023, Издательство "Педиатръ"2023"Paediatrician" Publishers LLCИздательство "Педиатръ"https://vestnikramn.spr-journal.ru/jour/about/submissionshttps://vestnikramn.spr-journal.ru/jour/article/view/9965

Psoriasis (PsO) and atopic dermatitis (AD have much in common: both diseases are widespread, characterized by a chronic relapsing course, primarily affect the skin and lead to a quality reduction of life of patients, regardless of their age. The pathogenesis of these two dermatoses, which are the most common in the practice of a pediatric dermatologist, is quite different. PsO is a chronic inflammatory skin disease, the pathogenesis of which is associated with the involvement of the Th1 pathway: Th17 cells and the IL-23/IL-17 axis. AD, in turn, is usually associated with high levels of IL-4, IL-5, IL-13, IL-31 and IFN-γ produced by activated T-helper 2 (Th2) cells. The clinical symptoms and immunopathological responses of these two skin conditions tend to differ. However, patients with PsO may sometimes present with a skin rash resembling AD combined with intense itching and laboratory increase in immunoglobulin E (IgE) which may indicate the need to change the paradigm of dominance of only one type of T-inflammation in patients with these diseases.

Псориаз (ПсО) и атопический дерматит (АтД) имеют много общего: оба заболевания широко распространены, характеризуются хроническим рецидивирующим течением, поражают в первую очередь кожный покров и приводят к снижению качества жизни пациентов независимо от их возраста. Патогенез этих двух дерматозов, наиболее часто встречающихся в практике детского дерматолога, довольно сильно отличается. ПсО представляет собой хроническое воспалительное заболевание кожи, патогенез которого связан с задействованием Тh1-пути: клеток Th17 и оси IL-23/IL-17. АтД, в свою очередь, обычно связан с высокими уровнями IL-4, IL-5, IL-13, IL-31 и IFN-γ, продуцируемыми активированными Т-хелперами 2 (Th2) клетками. Клинические проявления и иммунопатологические реакции этих двух состояний кожи, как правило, имеют различия. Однако у пациентов с ПсО иногда могут быть высыпания на коже, напоминающие АтД, в сочетании с интенсивным зудом и лабораторным повышением уровня иммуноглобулина класса Е (IgE), что может свидетельствовать о необходимости смены парадигмы доминирования лишь одного типа Т-воспаления у пациентов с этими заболеваниями.

psoriasisatopic dermatitisIgEPsEmaPsAllergyпсориазатопический дерматитиммуноглобулин EPsEmaPsAllergyНИИ педиатрии и охраны здоровья детей Научно-клинического центра № 2 ФГБНУ «РНЦХ им. акад. Б.В. Петровского»Pediatrics and Child Health Research Institute in Petrovsky National Research Centre of SurgeryРоссийский национальный исследовательский медицинский университет имени Н.И. ПироговаPirogov Russian National Research Medical University (Pirogov Medical University)Christophers E, Henseler T. Contrasting disease patterns in psoriasis and atopic dermatitis. Arch Dermatol Res. 1987;279(Suppl):S48–51. doi: https://doi.org/10.1007/BF00585919Garofalo L, Pisani V, Mazzotta F, et al. Psoriasis in atopic children. Acta Derm Venereol Suppl (Stockh). 1989;146:63–65.Benn CS, Bendixen M, Krause TG, et al. Questionable coexistence of TH1- and TH2-related diseases. J Allergy Clin Immunol. 2002;110(2):328–329. doi: https://doi.org/10.1067/mai.2002.126480Lowes MA, Kikuchi T, Fuentes-Duculan J, et al. Psoriasis vulgaris lesions contain discrete populations of Th1 and Th17 T cells. J Invest Dermatol. 2008;128(5):1207–1211. doi: https://doi.org/10.1038/sj.jid.5701213Li LF, Sujan SA, Yang H, et al. Serum immunoglobulins in psoriatic erythroderma. Clin Exp Dermatol. 2005;30(2):125–127. doi: https://doi.org/10.1111/j.1365-2230.2004.01717.xOvcina-Kurtovic N, Kasumagic-Halilovic E. Serum levels of total immunoglobulin E in patients with psoriasis: relationship with clinical type of disease. Med Arh. 2010;64(1):28–29.Maliyar K, Sibbald C, Pope E, et al. Diagnosis and Management of Atopic Dermatitis. Adv Skin Wound Care. 2018;31(12):538–550. doi: https://doi.org/10.1097/01.asw.0000547414.38888.8dМурашкин Н.Н., Намазова-Баранова Л.С., Опрятин Л.А., и др. Биологическая терапия среднетяжелых и тяжелых форм атопического дерматита в детском возрасте // Вопросы современной педиатрии. — 2020. — Т. 19. — № 6. — С. 432–443. [Murashkin NN, Namazova-Baranova LS, Opryatin LA, et al. Biologic Therapy of Moderate and Severe Forms of Atopic Dermatitis in Children. Voprosy sovremennoi pediatrii — Current Pediatrics. 2020;19(6):432–443. (In Russ.)] doi: https://doi.org/10.15690/vsp.v19i6.2145McGirt LY, Beck LA. Innate immune defects in atopic dermatitis. J Allergy Clin Immunol. 2006;118(1):202–208. doi: https://doi.org/10.1016/j.jaci.2006.04.033Bao L, Zhang H, Chan LS. The involvement of the JAK-STAT signaling pathway in chronic inflammatory skin disease atopic dermatitis. JAKSTAT. 2013;2(3):e24137. doi: https://doi.org/10.4161/jkst.24137Lundin A, Fredens K, Michaëlsson G, et al. The eosinophil granulocyte in psoriasis. Br J Dermatol. 1990;122(2):181–193. doi: https://doi.org/10.1111/j.1365-2133.1990.tb08264.xGuttman-Yassky E, Suárez-Fariñas M, Chiricozzi A, et al. Broad defects in epidermal cornification in atopic dermatitis identified through genomic analysis. J Allergy Clin Immunol. 2009;124(6):1235–1244.e58. doi: https://doi.org/10.1016/j.jaci.2009.09.031Elias PM, Hatano Y, Williams ML. Basis for the barrier abnormality in atopic dermatitis: outside-inside-outside pathogenic mechanisms. J Allergy Clin Immunol. 2008;121(6):1337–1343. doi: https://doi.org/10.1016/j.jaci.2008.01.022Proksch E, Brandner JM, Jensen JM. The skin: an indispensable barrier. Exp Dermatol. 2008;17(12):1063–1072. doi: https://doi.org/10.1111/j.1600-0625.2008.00786.xMoy AP, Murali M, Kroshinsky D, et al. Immunologic Overlap of Helper T-Cell Subtypes 17 and 22 in Erythrodermic Psoriasis and Atopic Dermatitis. JAMA Dermatol. 2015;151(7):753–760. doi: https://doi.org/10.1001/jamadermatol.2015.2Kero J, Gissler M, Hemminki E, et al. Could TH1 and TH2 diseases coexist? Evaluation of asthma incidence in children with coeliac disease, type 1 diabetes, or rheumatoid arthritis: A register study. J Allergy Clin Immunol. 2001;108(5):781–783. doi: https://doi.org/10.1067/mai.2001.119557Joel MZ, Fan R, Damsky W, e al. Psoriasis associated with asthma and allergic rhinitis: a US-based cross-sectional study using the All of US Research Program. Arch Dermatol Res. 2023;315(6):1823–1826. doi: https://doi.org/10.1007/s00403-023-02539-zChowdhury BA. Comparative efficacy of levalbuterol and racemic albuterol in the treatment of asthma. J Allergy Clin Immunol. 2002;110(2):324. doi: https://doi.org/10.1067/mai.2002.126374Asmus MJ, Hendeles L, Weinberger M, et al. Levalbuterol has not been established to have therapeutic advantage over racemic albuterol. J Allergy Clin Immunol. 2002;110(2):325. doi: https://doi.org/10.1067/mai.2002.126375Schmuth M, Blunder S, Dubrac S, et al. Epidermal barrier in hereditary ichthyoses, atopic dermatitis, and psoriasis. J Dtsch Dermatol Ges. 2015;13(11):1119–1123. doi: https://doi.org/10.1111/ddg.12827Ortiz-Lopez LI, Choudhary V, Bollag WB. Updated Perspectives on Keratinocytes and Psoriasis: Keratinocytes are More Than Innocent Bystanders. Psoriasis (Auckl). 2022;12:73–87. doi: https://doi.org/10.2147/PTT.S327310Łuczaj W, Wroński A, Domingues P, et al. Lipidomic analysis reveals specific differences between fibroblast and keratinocyte ceramide profile of patients with psoriasis vulgaris. Molecules. 2020;25(3):630. doi: https://doi.org/10.3390/molecules25030630Барилло А.А., Смирнова С.В. Персонифицированный подход к диагностике и лечению больных псориазом // Российский иммунологический журнал. — 2021. — Т. 24. — № 4. — С. 455–460. [Barilo AA, Smirnova SV. Personalized approach to diagnostics and therapy of patients with psoriasis. Russian Journal of Immunology / Rossiyskiy Immunologicheskiy Zhurnal. 2021;24(4):455–460. (In Russ.)] doi: https://doi.org/10.46235/1028-7221-1074-PATGuttman-Yassky E, Krueger JG. Atopic dermatitis and psoriasis: two different immune diseases or one spectrum? Curr Opin Immunol. 2017;48:68–73. doi: https://doi.org/10.1016/j.coi.2017.08.008Ünal ES, Gül Ü, Dursun AB, et al. Prediction of atopy via total immunoglobulin E levels and skin prick tests in patients with psoriasis. Turk J Med Sci. 2017;47(2):577–582. doi: https://doi.org/10.3906/sag-1601-133Szegedi A, Aleksza M, Gonda A, et al. Elevated rate of Thelper1 (T(H)1) lymphocytes and serum IFN-gamma levels in psoriatic patients. Immunol Lett. 2003;86(3):277–280. doi: https://doi.org/10.1016/s0165-2478(03)00025-7Palmer CN, Irvine AD, Terron-Kwiatkowski A, et al. Common loss-of-function variants of the epidermal barrier protein filaggrin are a major predisposing factor for atopic dermatitis. Nat Genet. 2006;38(4):441–446. doi: https://doi.org/10.1038/ng1767Hollox EJ, Huffmeier U, Zeeuwen PL, et al. Psoriasis is associated with increased beta-defensin genomic copy number. Nat Genet. 2008;40(1):23–25. doi: https://doi.org/10.1038/ng.2007.48Cookson WO, Ubhi B, Lawrence R, et al. Genetic linkage of childhood atopic dermatitis to psoriasis susceptibility loci. Nat Genet. 2001;27(4):372–373. doi: https://doi.org/10.1038/86867Vinnik T, Kreinin A, Abildinova G, et al. Biological Sex and IgE Sensitization Influence Severity of Depression and Cortisol Levels in Atopic Dermatitis. Dermatology. 2020;236(4):336–344. doi: https://doi.org/10.1159/000504388Kasumagic-Halilovic E. Total Serum Immunoglobulin E Levels in Patients with Psoriasis. Mater Sociomed. 2020;32(2):105–107. doi: https://doi.org/10.5455/msm.2020.32.105-107Lotfi RA, El-Sayed MH, El-Gabry SH. Assessment of serum levels of IgE in psoriasis. Journal of the Egyptian Womenʼs Dermatologic Society. 2015;12(1):63–67. doi: https://doi.org/10.1097/01.ewx.0000450678.40084.23Chen C, Zheng X, Duan Q, et al. High Serum IgE Concentration in Patients with Psoriasis. Clin Res Dermatol Open Access. 2017;4(4):1–4. doi: https://doi.org/10.15226/2378-1726/4/4/00163Hasan T, Jansén CT. Erythroderma: A follow-up of fifty cases. J Am Acad Dermatol. 1983;8(6):836–840. doi: https://doi.org/10.1016/s0190-9622(83)80013-9Horiuchi Y. Senile erythroderma with hyper IgE: an independent and novel disease form. Asia Pac Allergy. 2022;12(2):e12. doi: https://doi.org/10.5415/apallergy.2022.12.e12Lajevardi V, Ghiasi M, Goodarzi A, et al. Total serum IgE concentration in patients with psoriasis: a case-control study. Acta Med Iran. 2014;52(7):515–518.Gebhardt M, Wenzel HC, Hipler UC, et al. Monitoring of serologic immune parameters in inflammatory skin diseases. Allergy. 1997;52(11):1087–10894. doi: https://doi.org/10.1111/j.1398-9995.1997.tb00180.xHosseini P, Khoshkhui M, Hosseini RF, et al. Investigation of the relationship between atopy and psoriasis. Postepy Dermatol Alergol. 2019;36(3):276–281. doi: https://doi.org/10.5114/ada.2019.85639Jelinek DF. Regulation of B lymphocyte differentiation. Ann Allergy Asthma Immunol. 2000;84(4):375–385. doi: https://doi.org/10.1016/S1081-1206(10)62267-3Bacharier LB, Geha RS. Molecular mechanisms of IgE regulation. J Allergy Clin Immunol. 2000;105(2Pt2):S547–558. doi: https://doi.org/10.1016/s0091-6749(00)90059-9Eckl-Dorna J, Villazala-Merino S, Campion NJ, et al. Tracing IgE-Producing Cells in Allergic Patients. Cells. 2019;8(9):994. doi: https://doi.org/10.3390/cells8090994Komi DEA, Mortaz E, Amani S, et al. The Role of Mast Cells in IgE-Independent Lung Diseases. Clin Rev Allergy Immunol. 2020;58(3):377–387. doi: https://doi.org/10.1007/s12016-020-08779-5Perez-Witzke D, Miranda-García MA, Suárez N, et al. CTLA4Fcε, a novel soluble fusion protein that binds B7 molecules and the IgE receptors, and reduces human in vitro soluble CD23 production and lymphocyte proliferation. Immunology. 2016;148(1):40–55. doi: https://doi.org/10.1111/imm.12586Conti P, Gallenga CE, Ronconi G, et al. Activation of mast cells mediates inflammatory response in psoriasis: Potential new therapeutic approach with IL-37. Dermatol Ther. 2019;32(4):e12943. doi: https://doi.org/10.1111/dth.12943Georgescu SR, Tampa M, Caruntu C, et al. Advances in Understanding the Immunological Pathways in Psoriasis. Int J Mol Sci. 2019;20(3):739. doi: https://doi.org/10.3390/ijms20030739Yan KX, Huang Q, Fang X, et al. IgE and FcεRI are highly expressed on innate cells in psoriasis. Br J Dermatol. 2016;175(1):122–133. doi: https://doi.org/10.1111/bjd.14459Guttman-Yassky E, Lowes MA, Fuentes-Duculan J, et al. Major differences in inflammatory dendritic cells and their products distinguish atopic dermatitis from psoriasis. J Allergy Clin Immunol. 2007;119(5):1210–1217. doi: https://doi.org/10.1016/j.jaci.2007.03.006Schäbitz A, Eyerich K, Garzorz‐Stark N. So close, and yet so far away: The dichotomy of the specific immune response and inflammation in psoriasis and atopic dermatitis. J Intern Med. 2021;290(1):27–39. doi: https://doi.org/10.1111/joim.13235Abramovits W, Cockerell C, Stevenson LC, et al. PsEma — a hitherto unnamed dermatologic entity with clinical features of both psoriasis and eczema. Skinmed. 2005;4(5):275–281. doi: https://doi.org/10.1111/j.1540-9740.2005.03636.xShi L, Liu C, Xiong H, et al. Elevation of IgE in patients with psoriasis: Is it a paradoxical phenomenon? Front Med (Lausanne). 2022;9:1007892. doi: https://doi.org/10.3389/fmed.2022.1007892Tsai YC, Tsai TF. Overlapping Features of Psoriasis and Atopic Dermatitis: From Genetics to Immunopathogenesis to Phenotypes. Int J Mol Sci. 2022;23(10):5518. doi: https://doi.org/10.3390/ijms23105518