Allergic contact dermatitis in psoriasis patients: Typical, delayed, and non-interacting

Maria Quaranta, Stefanie Eyerich, Bettina Knapp, Francesca Nasorri, Claudia Scarponi, Martina Mattii, Natalie Garzorz, Anna T. Harlfinger, Teresa Jaeger, Martine Grosber, Davide Pennino, Martin Mempel, Christina Schnopp, Fabian J. Theis, Cristina Albanesi, Andrea Cavani, Carsten B. Schmidt-Weber, Johannes Ring, Kilian Eyerich

Research output: Contribution to journalArticlepeer-review

33 Scopus citations


Psoriasis is characterized by an apoptosis-resistant and metabolic active epidermis, while a hallmark for allergic contact dermatitis (ACD) is T cell-induced keratinocyte apoptosis. Here, we induced ACD reactions in psoriasis patients sensitized to nickel (n = 14) to investigate underlying mechanisms of psoriasis and ACD simultaneously. All patients developed a clinically and histologically typical dermatitis upon nickel challenge even in close proximity to pre-existing psoriasis plaques. However, the ACD reaction was delayed as compared to non-psoriatic patients, with a maximum intensity after 7 days. Whole genome expression analysis revealed alterations in numerous pathways related to metabolism and proliferation in non-involved skin of psoriasis patients as compared to non-psoriatic individuals, indicating that even in clinically non-involved skin of psoriasis patients molecular events opposing contact dermatitis may occur. Immunohistochemical comparison of ACD reactions as well as in vitro secretion analysis of lesional T cells showed a higher Th17 and neutrophilic migration as well as epidermal proliferation in psoriasis, while ACD reactions were dominated by cytotoxic CD8+ T cells and a Th2 signature. Based on these findings, we hypothesized an ACD reaction directly on top of a pre-existing psoriasis plaque might influence the clinical course of psoriasis. We observed a strong clinical inflammation with a mixed psoriasis and eczema phenotype in histology. Surprisingly, the initial psoriasis plaque was unaltered after self-limitation of the ACD reaction. We conclude that sensitized psoriasis patients develop a typical, but delayed ACD reaction which might be relevant for patch test evaluation in clinical practice. Psoriasis and ACD are driven by distinct and independent immune mechanisms.

Original languageEnglish
Article numbere101814
JournalPLoS ONE
Issue number7
StatePublished - 24 Jul 2014


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