Abstract

A case of 22-year-old man with atopic dermatitis (AD) who developed concurrent psoriasis vulgaris (PSO) is presented. PSO is primarily mediated by T-helper (Th) 17 immune responses, whereas AD is predominantly Th2-mediated. Both are distinct diseases, but overlapping cases occur, suggesting they may represent opposite ends of a spectrum of T-cell–mediated inflammatory diseases. The clinical course of this case demonstrates an interesting example of the immunological instability of AD. Base on his clinical feature, this case is suggested to be an intrinsic, Th17-dominant phenotypes different from that of typical AD. The clinical course of this case suggests that the immune environment of intrinsic AD shifted to the opposite direction. Cytokine-targeted therapies may shift immune responses across the disease spectrum. Therefore, upadacitinib, a Janus kinase (JAK) inhibitor, was selected, leading to the satisfactory result. Treatment of atopic dermatitis requires individualized therapeutic choices.