Cytokine Soup Part 2: Closing the Loops On Types of Inflammation

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes back Jason Hawkes, MD, MS, for the second installment of their discussion on the “cytokine soup” underlying inflammatory skin diseases. Building on their previous conversation about type 2 inflammation, they turn their attention to type 1 and type 3 inflammatory pathways, examining how these immune responses contribute to disease manifestations and influence therapeutic approaches.

Dr Hawkes begins by clarifying the terminology surrounding T-helper cell populations and broader inflammatory pathways, including the distinction between Th1, Th2, and Th17 responses and type 1, type 2, and type 3 inflammation. He explains how immune cells develop distinct inflammatory profiles and why understanding the signals that drive these responses is increasingly important as targeted therapies continue to expand.

The conversation then shifts to psoriasis, a prototypical type 3 inflammatory disease, and the complexities that arise when multiple inflammatory pathways contribute to a patient's clinical presentation. Dr Hawkes discusses how the immune mechanisms underlying plaque psoriasis may differ from those involved in psoriatic arthritis, helping explain why skin and joint responses to treatment do not always align. The clinicians also examine how differences in inflammatory pathways contribute to infection susceptibility in psoriasis and atopic dermatitis, as well as certain adverse effects associated with targeted therapies.

Finally, Drs Del Rosso and Hawkes explore the immunologic diversity of psoriasis, from classic plaque disease to guttate, pustular, erythrodermic, and paradoxical presentations. They discuss how a better understanding of the inflammatory mechanisms underlying these distinct phenotypes may help explain variations in clinical presentation and response to treatment, bringing dermatology closer to more individualized therapeutic decision-making.

Tune in to the episode for a clinically grounded discussion of inflammatory pathways, the relationship between immune signaling and disease manifestations, and why understanding the science behind targeted therapies can help dermatologists make sense of what they observe in everyday practice.