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Böhner, A.* ; Jargosch, M. ; Müller, N.S. ; Garzorz-Stark, N.* ; Pilz, A.C. ; Lauffer, F.* ; Wang, R.* ; Roenneberg, S.* ; Zink, A.* ; Thomas, J.* ; Theis, F.J. ; Biedermann, T.* ; Eyerich, S. ; Eyerich, K.*

The neglected twin: Nummular eczema is a variant of atopic dermatitis with codominant TH2/TH17 immune response.

J. Allergy Clin. Immunol. 152, 408-419 (2023)
DOI PMC
Open Access Green as soon as Postprint is submitted to ZB.
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: We compared the clinical, histopathologic, and molecular signatures of NE with that of type 2 and type 3 skin diseases. METHODS: We performed bulk RNA sequencing as well as histologic and clinical studies in lesional and nonlesional 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 Ki-67+ cells, and neutrophilic infiltration. At the gene expression level, neutrophil-attracting cytokines (IL19, CXCL8, CXCL5) were upregulated, whereas TH2-related cytokines (IL13, CCL17, CCL18, CCL26, CCL27) were similarly 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: NE shows overlapping type 2 and type 3 immune signatures, while type 2 immunity predominates 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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Publication type Article: Journal article
Document type Scientific Article
Corresponding Author
Keywords Inflammatory Skin Diseases ; Atopic Dermatitis ; Dupilumab ; Nummular Eczema; Molecular Signatures; Clinical-features; Skin; Expression; Psoriasis; Dupilumab; Allergy; T(h)2
ISSN (print) / ISBN 0091-6749
e-ISSN 1097-6825
Journal The journal of allergy and clinical immunology
Quellenangaben Volume: 152, Issue: 2, Pages: 408-419 Article Number: , Supplement: ,
Publisher Elsevier
Publishing Place Amsterdam [u.a.]
Non-patent literature Publications
Reviewing status Peer reviewed
Institute(s) Institute for Allergy Research (IAF)
Institute of Computational Biology (ICB)
Grants Helmholtz Association ("Impuls-und Vernetzungsfonds")
German Research Foundation
European Research Council