A molecular map enables personalized skin treatment

Skin diseases like eczema, psoriasis, and lupus are caused by an overactive immune system that induces inflammation. Today, new treatments are available that effectively target these types of inflammation. However, some patients do not respond. Either because of a wrong diagnosis or because the chosen treatment does not match the specific kind of inflammation in their skin. Dermatologists are often challenged by the lack of accessible tools to help identify the dominant type of inflammation in their patients’ skin. 

Teofila Seremet Caplanusi, Jeremy Di Domizio, and Antoine Girardin took matters into their hands and developed a practical immunological tool that assists doctors in making an accurate diagnosis and in selecting an appropriate treatment. Their new method analyzes gene expression patterns, also known as “molecular signatures”, from a small skin sample and places them onto a map of different immune pathways. The information is based on seven gene expression units corresponding to major immune pathways: Th17, Th2, Th1, type I interferons, neutrophilic, macrophagic, and eosinophilic responses. The researchers created this map by comparing different molecular signatures across many inflammatory skin diseases in hundreds of patients, and were able to match each signature to the corresponding immune pathway responsible for the inflammation in each case. 

Especially in patients who do not respond to treatment, identifying the dominant immune signal in their skin provides new insights into their specific disease progression pathways. This new molecular map can help clinicians to identify the underlying inflammatory pathway in well-known skin conditions as well as in difficult cases like widespread rashes or unspecific symptoms. It further provides a scientific way to match each patient with the treatment that best fits their specific type of inflammation. 

The work of the prize winners allows to enter a new era of precision medicine in dermatology, thanks to enabling a deeper understanding of the immune pathways behind skin inflammation. For the first time, clinicians now have a tool to individually identify the specific active immune pathway in each case. Thereby, this molecular map not only helps to make an accurate diagnosis but also to match each patient to the most effective, targeted therapy.