Revisiones_bibliográficas TyO_Web

Mutual Antagonism of T Cells Causing Psoriasis and Atopic Eczema

Stefanie Eyerich, Ph.D., Anna T. Onken, M.D., Stephan Weidinger, M.D., Andre Franke, M.D., Francesca Nasorri, Ph.D., Davide Pennino, Martine Grosber, M.D., Florian Pfab, M.D., Carsten B. Schmidt-Weber, Ph.D., Martin Mempel, M.D., Ruediger Hein, M.D., Johannes Ring, M.D., Ph.D., Andrea Cavani, M.D., Ph.D., and Kilian Eyerich, M.D., Ph.D.

N Engl J Med 2011; 365:231-238July 21, 2011

The simultaneous occurrence of psoriasis driven by type 1 helper T (Th1) cells and type 17 helper T (Th17) cells and atopic eczema dominated by type 2 helper T (Th2) cells is rare. Here, we describe three patients with co-occurring psoriasis and atopic eczema with an antagonistic course and distinct T-cell infiltrates in lesions from psoriasis and those from atopic eczema. Sensitized patients with psoriasis had a reaction to epicutaneous allergen challenge, with clinically and histologically verified eczema lesions containing a large number of allergen-reactive T cells. These findings support a causative role for T cells triggered by specific antigens in both psoriasis and atopic eczema. (Supported by the German Research Foundation and others.)

Supported by grants from Deutsche Forschungsgemeinschaft (EY97/1-2 and WE2678/4-1), Kommission Klinische Forschung of the Klinikum Rechts der Isar Munich, Hochschulwissenschaftsprogramm of the Technische Universität Munich, Bayerische Forschungsstiftung, the National Genome Research Network (01GS0809 and 01GS0818), and the Christine Kühne Center of Allergy Research and Education.

Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.

Drs. S. Eyerich and Onken contributed equally to this article.

We thank Juliette Kranz for technical assistance.

SOURCE INFORMATION

From the Center of Allergy and Environment (ZAUM), Technische Universität and Helmholtz Center Munich (S.E., D.P., C.B.S.-W.), and the Department of Dermatology and Allergy, Technische Universität Munich (A.T.O., M.G., F.P., R.H., J.R., K.E.) — both in Munich; the Department of Dermatology, Allergology, and Venerology (S.W.) and the Institute of Clinical Molecular Biology (A.F.), University Hospital Schleswig–Holstein, Campus Kiel, Kiel; and the Department of Dermatology, Venereology, and Allergology, University Medicine Göttingen, Göttingen (M.M.) — all in Germany; and the Laboratory of Experimental Immunology, Istituto Dermopatico dell'Immacolata, Rome (F.N., A.C.).

Address reprint requests to Dr. Kilian Eyerich at the Department of Dermatology and Allergy, Technische Universität Munich, Biedersteiner Straße 29, 80802 Munich, Germany, or at kilian.eyerich@lrz.tum.de.

Access this article: Subscribe to NEJM | Purchase this article

MEDIA IN THIS ARTICLE

FIGURE 1Patients with Concomitant Psoriasis and Atopic Eczema (AE).

FIGURE 2Antigen-Specific Eczematous Reactions on Epicutaneous Challenge in Patients with Psoriasis and Allergic Sensitization