New Biomarker Test Revolutionizes Inflammatory Skin Disease Diagnosis

William Damsky, MD, PhD, an assistant professor of dermatology at Yale School of Medicine, is dedicated to advancing the understanding and treatment of inflammatory skin diseases. As both a practicing dermatologist and a dermatopathologist, Damsky recognizes the significant "practice gap between what's possible in the research laboratory" and what is currently available in clinical settings. This gap, he notes, is due to challenges such as specimen acquisition, processing expertise, turnaround time, and other logistical barriers. His research aims to bridge this gap by developing molecular diagnostics that can seamlessly integrate into dermatological practice.

The Need for Molecular Subclassification

Atopic dermatitis and psoriasis are 2 of the most common inflammatory skin diseases, yet they present with significant heterogeneity. "One patient with atopic dermatitis may not be exactly clinically or histologically or immunologically identical to the next," Damsky explains. This variability makes treatment decisions complex, as many FDA-approved therapies have distinct mechanisms of action, but there is little guidance on selecting the best medication for individual patients.

Identifying and Validating Biomarkers

To address this, Damsky and his team examined approximately 100 biomarkers, validating 10 before ultimately selecting4 that proved most effective. Their goal was to determine which molecular markers could best distinguish inflammatory skin diseases and predict treatment responses. They explored various laboratory techniques, ultimately settling on in situ hybridization over immunohistochemistry due to its superior ability to detect cytokines, which are critical to disease pathogenesis and targeted by many modern therapies.

A Clinically Compatible Workflow

A major advantage of Damsky' approach is that it requires no additional effort from clinicians or pathology labs. "The clinician doesn't need to do anything different. They just do a biopsy, as they always would," he explains. The biopsy can be a new or existing sample, allowing retrospective molecular classification of patients. By running the stains overnight using a standardized protocol, results are available the next morning, facilitating rapid and informed treatment decisions.

Transforming Dermatological Care

Damsky envisions a future where molecular diagnostics become routine in dermatology, enabling precise disease classification and more effective use of targeted therapies. This approach could be particularly transformative for rare or severe skin conditions that currently lack FDA-approved treatments. His collaboration with Molecular Instruments has been instrumental in developing RNA probes that preserve tissue morphology and produce clear signals, further enhancing the utility of this technique.

Conclusion

Inflammatory skin disease research is undergoing a "translational revolution," yet clinical practice still lags behind laboratory discoveries. By integrating molecular diagnostics into standard dermatological workflows, Damsky and his team hope to close this gap, ultimately improving patient outcomes and expanding treatment options for a wide range of skin diseases.