Clinical and dermoscopic response predictors in psoriatic patients undergoing narrowband ultraviolet B phototherapy: results from a prospective study

Reflectance confocal microscopy for plaque psoriasis therapeutic follow-up during an anti-interleukin-17A monoclonal antibody: an observational study

Interleukin-17A therapeutic inhibitors are among the most effective treatment methods for moderate-to-severe plaque psoriasis (PP). Reflectance confocal microscopy is a non-invasive imaging technique already documented to be beneficial in evaluating the follow-up of PP under treatment with topical actives and phototherapy. This study aimed to assess the epidermal and dermal changes associated with psoriasis and its treatment with RCM during systemic secukinumab treatment in patients with moderate-to-severe PP. A pilot study was conducted to evaluate RCM as a non-invasive tool for monitoring secukinumab treatment in patients with PP. For patients receiving secukinumab treatment, lesional skin was selected for RCM imaging, which were recorded at all scheduled times. The RCM evaluation criteria were established based on the histopathological diagnostic criteria for psoriasis. The clinical severity of psoriasis was assessed utilizing the psoriasis area severity index. A total of 23 patients with PP were included in the study. Each patient received 300 mg of subcutaneous secukinumab as induction therapy at baseline and weeks 1-4, followed by maintenance therapy every four weeks. Microscopic confocal changes were observed during the treatment. The results identified early microscopic evidence of the anti-inflammatory activity of secukinumab, which was not detected during the clinical examination. RCM findings correlating with the PASI were used to observe the patient's response to treatment and were identified as follows: acanthosis and parakeratosis, presence of epidermal and dermal inflammatory cells, presence of non-edge dermal papillae, and vascularization in the papillary dermis. This study is the first to demonstrate the use of RCM as an effective tool for non-invasive monitoring of secukinumab therapeutic response at a cellular level in a clinical or research setting. Early detection of RCM parameters associated with secukinumab activity may facilitate the identification of an early treatment response. RCM appears to be capable of providing practical and helpful information regarding follow-up in patients with PP undergoing secukinumab treatment. RCM may also provide novel perspectives on the subclinical evaluation of PP's response to biological therapy.

Inflammation and Psoriasis: A Comprehensive Review

Psoriasis is an immune-mediated disease with a strong genetic component that brings many challenges to sick individuals, such as chronic illness, and which has multiple associated comorbidities like cardiovascular disease, metabolic syndrome, inflammatory bowel disease, and psychological disorders. Understanding the interplay between the innate and adaptative immune system has led to the discovery of specific cytokine circuits (Tumor Necrosis Factor-alpha (TNF-α), IL-23, IL-17), which has allowed scientists to discover new biomarkers that can be used as predictors of treatment response and pave the way for personalized treatments. In this review, we describe the footprint psoriasis leaves on the skin and beyond, key pathophysiological mechanisms, current available therapeutic options, and drawbacks faced by existing therapies, and we anticipate potential future perspectives that may improve the quality of life of affected individuals.

[Dermoscopy of inflammatory skin diseases]

The dermoscope was initially used in dermatology to distinguish between pigmented and nonpigmented tumors, both benign and malignant. Over the last two decades, however, the spectrum of dermoscopy has broadened and its role in the diagnosis of nonneoplastic diseases, in particular inflammatory skin diseases, has become increasingly important. In the diagnosis of general and inflammatory skin diseases, it is recommended that dermoscopic evaluation should be performed after clinical examination. In the following summary, the dermoscopic features of the most common inflammatory skin diseases are described. Among the detailed parameters are the vascular structures, color, scaling, follicular findings, and specific signs associated with each disease.

Assessment of vascular patterns during the treatment of psoriatic patients using narrow-band ultraviolet B phototherapy by the dermoscope

BACKGROUND

Phototherapy is a traditional treatment for psoriasis and patients using it for a long time may be exposed to cumulative toxicity, so dermatologists need continuously diagnostic tools that help in monitoring the disease progression.

OBJECTIVES

To detect dermoscopic changes with the improvement of skin in patients with chronic plaque psoriasis on narrow-band ultraviolet B phototherapy and evaluate the role of dermoscopy in monitoring the patients.

METHODS

Narrowband ultraviolet B phototherapy was prescribed to thirty (30) patients with chronic plaque psoriasis for three months according to their disease condition. Psoriasis area and severity index (PASI score) were calculated, and dermoscopic evaluation was done at the first visit (W0), after 6 weeks, and after 12 weeks of beginning the phototherapy.

RESULTS

According to PASI score calculations, a significant correlation was found between changes in the vessel patterns and the improvement that occurred during the treatment sessions in psoriatic lesions, whereas the patients with globular blood vessels were significantly associated with weak clinical results.

CONCLUSION

Dermoscopy is a rapid, simple tool to predict the response of psoriatic patients to phototherapy using vascular pattern assessment.

Can Dermoscopy and Ultrasonography be Considered a Prognostic Tool in Management of Psoriasis?

Background:

Dermoscopy can reliably predict the diagnosis of plaque psoriasis. Ultrasonography has been increasingly used in dermatology in inflammatory diseases like psoriasis as a tool for evaluation. Hence, this study was done to evaluate the role of dermoscopy and ultrasonography as prognostic aid in plaque psoriasis.

Aims and Objectives:

To study the sonographic and dermoscopic findings of clinically diagnosed psoriatic lesions and the changes in the psoriatic lesions if any, with the treatment. How these findings can be utilized to assess the prognosis in these patients.

Materials and Methods:

The present study comprised 50 patients with clinically diagnosed plaque psoriasis. Lesions were assessed with Dino-Lite digital microscope AM7515MZT, followed by ultrasonography using a 15 MHz probe, and findings were recorded. All the patients included in this study were given appropriate treatment (topical/systemic) for 6 weeks and were followed up twice i.e., at 3 weeks and 6 weeks after initiating treatment.

Results:

Whitish scales were the most common scale color seen in our study seen in 35/50 patients (70%). All the vascular structures were reddish, red dots and globules being the predominant type and with the improvement of the lesions, brown structures increased. A total of 28 (56%) patients had a regular pattern of vessel arrangement. Mean capillary size was 0.097 ± 0.012 mm that reduced to 0.075 ± 0.019 mm at the end of the third week and 0.027 ± 0.032 mm at the end of 6 weeks. In ultrasonographic assessment, mean epidermal thickness reduced from 0.1008 to 0.0764 cm at third week and 0.068 cm at the sixth week, and mean dermal thickness reduced from 0.2692cm to 0.1906cm at the third week and then to 0.1906cm 0.1806cm at the sixth week. In our study, clinical improvement preceded dermoscopic improvement. Newer structures identified in the study are a perifollicular arrangement of capillaries and the presence of lacunar structures in the healing lesions.

Conclusion:

The scale distribution, capillary number, and capillary size in dermoscopic assessment, and epidermal and dermal thickness in ultrasonography showed statistically significant changes with treatment and thus may be taken as the prognostic indicators. Thus, both these noninvasive modalities may be useful in the therapeutic monitoring of plaque psoriasis.

Dermatoscopy of Inflammatory Diseases in Skin of Color

Dermatoscopy is a relevant in vivo diagnostic tool for inflammatory diseases of the skin that aids not only in diagnosis, but also in monitoring the response to treatment. The inflammatory diseases show dermoscopic patterns involving the vessels, scales, follicles, background hue, and special clues. This review aims to provide an overview on the use of dermoscopy in inflammatory dermatoses based on the available literature and the deviation from it in the skin of color (SOC) as there is paucity of literature in dermoscopy of inflammatory disorders in SOC. The dermatoscopic patterns in most of the inflammatory diseases in SOC are similar to that of white skin, with pigmentary changes being the prominent dermoscopic findings while vascular patterns and erythema being less evident.

Secukinumab and acitretin as a combination therapy for three clinical forms of severe psoriasis in multi-drug refractory patients: A case series of high efficacy and safety profile

Secukinumab, the first monoclonal antibody that inhibits interleukin-17A, has been shown to have rapid and long-lasting efficacy in the treatment of moderate-to-severe psoriasis. However, there are still difficult-to-treat cases in which even dose-escalation fails to provide a clinical response. In such cases, combining secukinumab with a conventional systemic agent may be a rational approach. Although methotrexate is most commonly preferred, acitretin may also be considered a good alternative, with its lower hepatotoxic potential. Data are limited regarding the use of combination therapy of secukinumab and acitretin for psoriasis. We herein present three patients with chronic plaque, generalized pustular and erythrodermic psoriasis, respectively, accompanied by multiple comorbidities, in whom skin clearance could not be achieved with several conventional and biologic therapies (including escalated dose regimens of secukinumab in two patients). Alternatively, we used a combination of secukinumab with low-dose acitretin, which resulted in a complete or almost complete skin clearance in all patients, with no adverse events or increased toxicity. Based on our real-life clinical experience with those patients, acitretin seems an effective and safe option to be used in combination with secukinumab. Even in patients who are refractory to multiple drugs including escalated doses of secukinumab, the addition of low-dose acitretin may be helpful in achieving treatment goals, decreasing the need for switching to another biologic therapy.

Dermoscopy in Monitoring and Predicting Therapeutic Response in General Dermatology (Non-Tumoral Dermatoses): An Up-To-Date Overview

Besides the well-known use in supporting the non-invasive diagnosis of non-tumoral dermatoses (general dermatology), dermoscopy has been shown to be a promising tool also in predicting and monitoring therapeutic outcomes of such conditions, with the consequent improvement/optimization of their treatment. In the present paper, we sought to provide an up-to-date overview on the use of dermoscopy in highlighting response predictor factors and evaluating therapeutic results in the field of general dermatology according to the current literature data. Several dermatoses may somehow benefit from such applications, including inflammatory conditions (psoriasis, lichen planus, dermatitis, granulomatous conditions, erythro-telangiectatic rosacea, Zoon balanitis and vulvitis, cutaneous mastocytosis, morphea and extra-genital lichen sclerosus), pigmentary disorders (vitiligo and melasma) and infectious dermatoses (scabies, pediculosis, demodicosis and viral warts).

Plaque-Type Psoriasis Treated with Calcipotriene Plus Betamethasone Dipropionate Aerosol Foam: A Prospective Study on Clinical and Dermoscopic Predictor Factors in Response Achievement and Retention

Introduction

Little information on possible local factors that can influence the achievement and retention of response of plaque-type psoriasis to calcipotriene plus betamethasone dipropionate aerosol foam is available. The aim of this study was to assess possible correlations between baseline clinical/dermoscopic features of psoriatic plaques and therapeutic response, and between residual dermoscopic findings in clinically improved/healed lesions and post-treatment relapse.

Methods

For each target lesion, we calculated the local psoriasis severity index and assessed dermoscopic findings at baseline and at the end of a 4-week treatment, correlating the therapeutic outcome with the initial clinical and dermoscopic features. The lesions were also followed for a 4-week post-treatment period, and possible associations between relapse and (1) baseline clinical/dermoscopic features and (2) dermoscopic findings detected at the end of the treatment were assessed.

Results

A total of 105 lesions from 35 patients were included in the analysis. After 4 weeks of therapy, 13 lesions showed no/limited improvement, while partial and optimal response were observed in 51 and 41 plaques, respectively. Poor outcomes were correlated with both legs localization and degree of lesion infiltration at baseline. Similarly, presence of globular vessels at baseline dermoscopy was more commonly associated with no/limited response and lesions on the legs, particularly those showing resistance to treatment. A correlation was also found between dotted vessels on the baseline dermoscopic examination and good outcomes (partial/optimal response). After a 4-week post-treatment follow-up, 58.7% of the lesions achieving improvement at the end of the therapy showed relapse, with a correlation between recurrence and vessel persistence on dermoscopy at the end of the therapy.

Conclusion

Clinical response of plaque-type psoriasis to calcipotriol/betamethasone dipropionate spray foam may be adversely affected by the degree of infiltration of lesions at baseline and by legs localization, and the presence of globular vessels at the baseline dermoscopic assessment is related to poor outcomes. A significant post-treatment relapse rate was observed, and persistence of vascular changes on dermoscopy seems to play a role in promoting disease recurrence.

Dermoscopy of Inflammatory Dermatoses (Inflammoscopy): An Up-to-Date Overview

In addition to its use in pigmented and nonpigmented skin tumors, dermoscopy is gaining appreciation in assisting the diagnosis of nonneoplastic diseases, especially inflammatory dermatoses (inflammoscopy). In this field, dermoscopic examination should be considered as the second step of a "2-step procedure," always preceded by the establishment of a differential diagnosis on the basis of clinical examination. In this paper, we sought to provide an up-to-date overview on the use of dermoscopy in common inflammatory dermatoses based on the available literature data. For practical purposes, the analyzed dermatoses are grouped according to the clinical presentation pattern, in line with the 2-step procedure principle: erythematous-desquamative and papulosquamous dermatoses, papulokeratotic dermatoses, erythematous facial dermatoses, sclero-atrophic dermatoses, and miscellaneous.