A Case of Biologic-Resistant Hand Dermatitis Demonstrates Dual T2/T17 Transcriptomic Abnormalities and Responds to JAK Inhibition

Many patients do not respond to targeted pathway-specific biologic therapies but predicting such failure remains an outstanding challenge. Here, in a case of adult-onset hand dermatitis that did not respond to multiple targeted biologic therapies, we detected gene expression programs activated in both atopic dermatitis and psoriasis, via high-resolution genetic profiling. Broader, kinase-based immunosuppression elicited a near complete clinical response. Therefore, our data suggest that such cases harboring greater molecularly complexity might be identified prospectively, circumventing some failures of single pathway blockade.