Eczema–Psoriasis Overlap: An eDelphi Consensus on Clinical Presentation and Therapeutic Management Among Italian Experts

Atopic dermatitis and psoriasis (PsO) are common chronic inflammatory skin diseases traditionally considered distinct, driven by Th2 and Th1/Th17 pathways, respectively. However, evidence reveals that some patients may present with both eczematous and psoriatic lesions, either simultaneously or sequentially. This study’s objective was to establish an Italian consensus on the clinical definition and management of eczema–psoriasis overlap. A steering committee of eight dermatologists identified three key areas: problem definition, clinical presentation and therapeutic management. Forty-three statements were drafted and distributed to 131 dermatologists for evaluation via an eDelphi process, using a 1–9 numeric rating scale. Consensus was defined as a mean score ≥ 7. Of the 131 invited participants, 104 responded (79.4%). Consensus was reached for 42/43 statements. The only statement that failed to achieve consensus concerned the influence of respiratory atopic comorbidities on biologic choice in PsO; as a result of its dichotomous nature, it was not revised or re-voted on. Eczema and PsO exist on a continuum of immune dysregulation, which may manifest sequentially or concomitantly, with phenotypic switches that can be spontaneous or drug induced. Assessment of risk factors for drug-induced forms should guide therapeutic choices. Mild cases can often be managed with topical therapies, while moderate-to-severe forms may require broader T cell-targeting treatments. Eczema and psoriasis are two common chronic inflammatory skin diseases. They were usually considered distinct, but increasing evidence shows that some patients may experience features of both conditions, either at different times in life or simultaneously. In certain cases, treatment for one disease may trigger development of the other, making diagnosis and management more complex. This research was conducted in Italy with the aim of defining eczema–psoriasis overlap and providing practical guidance for its diagnosis and treatment. A group of eight dermatologists with experience in inflammatory skin disorders developed 43 statements on disease definition, clinical features and management. These were then evaluated by 104 Italian dermatologists in an online consensus (eDelphi method). Agreement was reached for 42 of the 43 statements. The results highlight that eczema and psoriasis may lie along a continuum of immune dysregulation, with some patients showing transitions between the two conditions over time. Drug-induced forms can occur during biologic therapy and should be recognized early. Mild presentations can often be managed with topical treatments, while moderate-to-severe overlap may require systemic therapies that modulate a broader range of immune pathways. This consensus provides clinicians with a structured framework for identifying overlap cases and selecting the most appropriate treatment, supporting more personalized and informed management decisions for patients.