Skin diseases such as psoriasis and eczema are more than just surface-level conditions—they often have deeper, systemic consequences that researchers are still working to understand. These inflammatory diseases can significantly impact quality of life, and in some cases, they lead to complications such as arthritis. Despite medical advancements, challenges remain in diagnosing, treating, and predicting these conditions. Two major research initiatives—HIPPOCRATES and BIOMAP—are striving to bridge these knowledge gaps. Their work is shedding light on the underlying mechanisms of psoriasis and eczema while developing better ways to predict and manage disease progression.
A Delayed Diagnosis with Lifelong Consequences
For Maarten de Wit, the struggle with psoriatic arthritis (PsA) began in his teenage years. In the 1970s, as a young man in the Netherlands, he suffered from intense joint pain that affected multiple areas of his body. Yet, it wasn’t until he turned 19 that he finally received a diagnosis. At the time, arthritis was largely perceived as a condition affecting the elderly, and few considered that a teenager could develop such a disease.
PsA is a form of arthritis that arises in people with psoriasis, a non-communicable skin disorder characterized by the rapid growth of skin cells. This accelerated cell turnover leads to scaly, itchy patches, typically appearing on the elbows, knees, and scalp. While some people with psoriasis may never develop PsA, others experience debilitating joint inflammation that restricts mobility and daily activities. Diagnosing PsA remains difficult, as its symptoms can mimic other forms of arthritis. By the time a diagnosis is made, irreversible joint damage may have already occurred.
Reflecting on Experience
De Wit’s experience reflects the broader struggle faced by many PsA patients. For years, treatment options were limited, and pain management was often inadequate. However, in the 2000s, the emergence of biologic therapies—including immune modulators and monoclonal antibodies—transformed the treatment landscape. De Wit recalls the dramatic improvement he felt after starting these newer medications. “I could literally feel the pain going away from my hands, my knees, my feet,” he said.
Despite these advancements, many patients still experience delays in diagnosis and treatment. To address this issue, researchers have launched large-scale projects aimed at improving early detection and prevention strategies for PsA.
The HIPPOCRATES Project: Aiming for Earlier PsA Detection
One such initiative is the HIPPOCRATES project, a five-year research collaboration funded by the EU and the European pharmaceutical industry through the Innovative Medicines Initiative (IMI). The project brings together 27 research partners across Europe and is co-led by Stephen Pennington, a proteomics specialist, and Oliver FitzGerald, a consultant rheumatologist, both based at University College Dublin in Ireland.
FitzGerald emphasizes the importance of early diagnosis, noting that many PsA patients already have significant joint damage by the time they receive proper medical attention. “Lots of people end up with a late diagnosis when there may already be significant areas of damage that can’t be reversed,” he said.
Psoriasis itself is widespread, affecting around 2% of the global population—approximately 6.4 million people in Europe alone. Among those, up to 30% will develop PsA. However, predicting which psoriasis patients will go on to develop arthritis remains a challenge. Currently, no reliable biomarkers exist to determine which individuals are at the highest risk, nor are there clear indicators of which treatments will work best for each patient.
HIPPOCRATES aims to change that. The project is harnessing existing molecular, genomic, and clinical data from patients while also enrolling 25,000 adults with psoriasis in an online study. By leveraging artificial intelligence and machine-learning techniques, researchers hope to identify biological markers that could signal the early onset of PsA. If successful, their work could lead to diagnostic algorithms capable of assessing a psoriasis patient’s likelihood of developing arthritis.
Another key aspect of HIPPOCRATES is its patient-centric approach. De Wit, now an advocate for individuals with rheumatic conditions, serves as a representative for the European Alliance of Associations for Rheumatology (EULAR). He stresses the importance of involving patients in research from the start. FitzGerald agrees, saying, “It’s a crucial part of what we do that we hear the patient voice.”
Looking Beyond PsA: The Burden of Eczema
Psoriatic arthritis is just one example of the complications that can arise from inflammatory skin diseases. Another condition, eczema—also known as atopic dermatitis (AD)—affects an estimated 220 million people worldwide. Like psoriasis, AD is an immune-driven disorder with genetic and environmental influences. While it primarily manifests as dry, itchy, and cracked skin, eczema is also associated with other inflammatory conditions such as asthma and allergic rhinitis. The precise relationships among these diseases remain unclear, but they share common immune pathways that contribute to chronic inflammation.
Professor Stephan Weidinger, a dermatologist at Kiel University in Germany, leads a major EU-funded project called BIOMAP, which seeks to deepen the understanding of both psoriasis and eczema. BIOMAP, which is also supported by IMI, collaborates closely with HIPPOCRATES and brings together more than 30 academic and industry partners from across Europe. The project is set to conclude in March 2024 after five years of research.
“Psoriasis and AD are not only common skin diseases, they’re common diseases overall,” Weidinger explained. He points out that despite their prevalence, skin conditions are often underestimated in terms of their impact on individuals and society. “Skin diseases are often underappreciated—maybe because they’re usually not life-threatening. But the burden is huge, and the costs to society are enormous.”
BIOMAP’s Mission: Defining Disease Subtypes for Better Treatments
One of BIOMAP’s primary goals is to categorize distinct subtypes of psoriasis and eczema, or “endotypes,” based on molecular and genetic signatures. By analyzing data from over 50,000 patients, researchers are working to identify unique disease pathways that could influence how individuals respond to treatments.
The project has already made progress, with researchers identifying two distinct subtypes of eczema through blood samples. These findings could lead to more personalized treatment approaches, potentially sparing patients from trial-and-error medication regimens that may be ineffective or cause unwanted side effects.
Weidinger believes the ongoing analysis will provide further evidence of clearly distinguishable endotypes, which could revolutionize how these diseases are managed. In turn, this could lead to the development of new therapies tailored to specific patient subgroups, improving treatment efficacy and reducing healthcare costs.
A Future with More Effective and Accessible Treatments
Both HIPPOCRATES and BIOMAP underscore the growing recognition that inflammatory skin diseases require a multidisciplinary research approach. Dermatologists, rheumatologists, immunologists, and data scientists are working together to uncover insights that could reshape how psoriasis, eczema, and related conditions are diagnosed and treated.
While there is still much to learn, the advancements made in recent years offer hope to millions of patients worldwide. From machine-learning-driven diagnostic tools to personalized medicine, these projects are paving the way for a future in which individuals receive earlier, more effective, and more targeted treatments.
Medical Landscape
For de Wit, who once faced years of uncertainty and pain, such progress represents a profound shift. His own children—who have also experienced psoriasis—may one day benefit from a medical landscape where the delays and challenges he faced are no longer the norm.
As science continues to unlock the complexities of inflammatory skin diseases, the potential for improved quality of life is growing. The work of HIPPOCRATES and BIOMAP offers a glimpse into a future where earlier diagnosis, better treatments, and a deeper understanding of these conditions become a reality for patients worldwide.
Read More: The Effects of Psoriatic Arthritis on Tendons and Ligaments