020 Cytokine imbalance during targeted therapies for psoriasis and atopic dermatitis – the yin yang of Th17 and Th2

Biologics targeting specific cytokines and pathways have revolutionized the management of patients with chronic inflammatory diseases such as psoriasis. Although generally very safe, these treatments their limitations and, surprisingly, can aggravate pre-existing or induce novel diseases. Here, we present a cohort psoriasis developing new onset eczema during anti-IL17 treatment, an intriguing side effect IL-17 blockade largely unknown pathogenesis. The coexistence in single patient is uncommon given distinct opposing immune mechanisms. Upon collection anamnestic data evaluation clinical histopathological phenotypes, performed gene expression analyses skin biopsies using Nanostring technology order to better define signatures involved. All showed good response underlying treatment prior eczematous lesions. Moreover, they carried elevated IgE levels, indicating atopic predisposition. Gene revealed that predominant Th17 signature plaque entirely replaced by strong Th2 after morphologic switch eczema, seen dermatitis. Intriguingly, two dermatitis receiving anti-IL4R developed psoriasiform lesions shift from towards analysis. Our findings indicate dynamic equilibrium between Th17, controlling each other. Thus, propose “yin-yang” IL-4 IL17 representing antipodal vectors. This explains lead, predisposed patients, induction pathway via lifting mediator.