A case of biologic-resistant hand dermatitis demonstrates dual T2/T17 transcriptomic abnormalities and responds to Janus kinase 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 programmes 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 harbouring greater molecular complexity might be identified prospectively, circumventing some failures of single-pathway blockade.