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Li Q, Pang B, Dang E, Wang G. Endothelial Dysfunction in Psoriasis: An Integrative Review. J Invest Dermatol 2024; 144:1935-1942. [PMID: 38493385 DOI: 10.1016/j.jid.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/07/2024] [Accepted: 02/20/2024] [Indexed: 03/18/2024]
Abstract
Vascular endothelial cells (ECs), the inner layer of blood vessels, were previously considered to be a passive lining that facilitates cellular and molecular exchange. However, recent studies have revealed that ECs can respond to various stimuli and actively regulate vascular function and skin inflammation. Specific subtypes of ECs are known to have significant roles in a diverse range of physiological and pathological processes in the skin. This review suggests that EC dysfunction is both causal and consequential in the pathogenesis of psoriasis. Further investigations into dysregulated pathways in EC dysfunction may provide new insights for the treatment of psoriasis.
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Affiliation(s)
- Qingyang Li
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, People Republic of China
| | - Bingyu Pang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, People Republic of China
| | - Erle Dang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, People Republic of China
| | - Gang Wang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, People Republic of China.
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Negrutiu M, Danescu S, Popa T, Focsan M, Vesa SC, Szasz F, Baican A. Imaging Approach in the Diagnostics and Evaluation of the Psoriasis Plaque: A Preliminary Study and Literature Review. Diagnostics (Basel) 2024; 14:969. [PMID: 38786267 PMCID: PMC11120603 DOI: 10.3390/diagnostics14100969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/03/2024] [Accepted: 05/04/2024] [Indexed: 05/25/2024] Open
Abstract
(1) Background: the aim of the study was to demonstrate its usefulness in the field of imaging evaluation of plaque morphology in psoriasis vulgaris, with an emphasis on the use of confocal microscopy and other advanced skin-imaging techniques. (2) Methods: we conducted a prospective study over two years (July 2022-April 2024), on patients diagnosed with moderate or severe psoriasis vulgaris, treated in the dermatology department of our institution. We selected 30 patients, of whom 15 became eligible according to the inclusion and the exclusion criteria. A total of 60 psoriasis plaques were analyzed by dermatoscopy using a Delta 30 dermatoscope and Vidix 4.0 videodermoscope (VD), by cutaneous ultrasound (US) using a high-resolution 20 MHz linear probe, and by confocal microscopy, along with histopathological analysis. (3) Results: the study included fifteen patients with vulgar psoriasis, diagnosed histopathologically, of whom six were women and nine were men, with an average age of 55. Between two and six plaques per patient were selected and a total of sixty psoriasis plaques were analyzed by non-invasive imaging techniques. Twelve lesions were analyzed with ex vivo fluorescence confocal microscopy (FCM), compared to histology. US showed that the hyperechoic band and the lack of damage to the subcutaneous tissue were the most common criteria. The epidermis and dermis were found to be thicker in the area of psoriasis plaques compared to healthy skin. Dermatoscopy showed that the specific aspect of psoriasis plaques localized on the limbs and trunk was a lesion with an erythematous background, with dotted vessels with regular distribution on the surface and covered by white scales with diffuse distribution. The presence of bushy vessels with medium condensation was the most frequently identified pattern on VD. Good correlations were identified between the histological criteria and those obtained through confocal microscopy. (4) Conclusions: the assessment and monitoring of patients with psoriasis vulgaris can be conducted in a more complete and all-encompassing manner by incorporating dermatoscopy, ultrasonography, and confocal microscopy in clinical practice.
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Affiliation(s)
- Mircea Negrutiu
- Department of Dermatology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (M.N.); (S.D.); (A.B.)
| | - Sorina Danescu
- Department of Dermatology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (M.N.); (S.D.); (A.B.)
| | - Theodor Popa
- Department of Rehabilitation, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Monica Focsan
- Nanobiophotonics and Laser Microspectroscopy Center, Interdisciplinary Research Institute on Bio-Nano-Sciences, Babes-Bolyai University, 400271 Cluj-Napoca, Romania;
| | - Stefan Cristian Vesa
- Department of Functional Sciences, Discipline of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Florin Szasz
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Adrian Baican
- Department of Dermatology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (M.N.); (S.D.); (A.B.)
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Wang J, Zhu Q, Li F, Xiao M, Liu J. Clinical, dermoscopic, and ultrasonic monitoring of the response to biologic treatment in patients with moderate-to-severe plaque psoriasis. Front Med (Lausanne) 2023; 10:1162873. [PMID: 37435540 PMCID: PMC10330810 DOI: 10.3389/fmed.2023.1162873] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/02/2023] [Indexed: 07/13/2023] Open
Abstract
Background Assessment of therapeutic response of psoriasis has relied traditionally on clinical observation, and effective non-invasive tools are desirable. Objectives To investigate the value of dermoscopy and high-frequency ultrasound (HFUS) in the monitoring of psoriatic lesions treated with biologics. Methods Patients with moderate-to-severe plaque psoriasis treated with biologics were evaluated by clinical, dermoscopic, and ultrasonic scores at weeks 0, 4, 8, and 12. Clinical scores, including Psoriasis Area Severity Index (PASI) and target lesion score (TLS), were evaluated at representative lesions. Dermoscopy was performed to assess the red background, vessels, and scales on a 4-point scale as well as the presence of hyperpigmentation, hemorrhagic spots, and linear vessels. HFUS was performed to measure the thicknesses of the superficial hyperechoic band and subepidermal hypoechoic band (SLEB). The correlation between clinical, dermoscopic, and ultrasonic evaluation was also analyzed. Results In total, 24 patients were analyzed and achieved 85.3 and 87.5% reduction of PASI and TLS, respectively, after 12 weeks of treatment. The red background, vessels, and scales scores under dermoscopy were reduced by 78.5, 84.1, and 86.5%, respectively. Some patients developed hyperpigmentation and linear vessels after treatment. Hemorrhagic dots slowly subside over the therapeutic course. Ultrasonic scores were significantly improved with an average reduction of 53.9% in superficial hyperechoic band thickness and 89.9% in SLEB thickness. TLS in the clinical variables, scales in dermoscopic variables, and SLEB in ultrasonic variables decreased the most significantly in the early stage of treatment (week 4) with 55.4, 57.7, and 59.1% (P > 0.05), respectively. Most of the variables, including the red background, vessels, scales, and SLEB thickness, were strongly correlated with TLS. High correlations were also found between the SLEB thickness and the red background or vessels scores, and between the superficial hyperechoic band thickness and the scales scores. Conclusion Both dermoscopy and HFUS were useful in the therapeutic monitoring of moderate-to-severe plaque psoriasis.
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Affiliation(s)
- Juncheng Wang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Qingli Zhu
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feng Li
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Mengsu Xiao
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie Liu
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
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Hindelang B, Nau T, Englert L, Berezhnoi A, Lauffer F, Darsow U, Biedermann T, Eyerich K, Aguirre J, Ntziachristos V. Enabling precision monitoring of psoriasis treatment by optoacoustic mesoscopy. Sci Transl Med 2022; 14:eabm8059. [PMID: 35544596 DOI: 10.1126/scitranslmed.abm8059] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Psoriasis is a widespread inflammatory skin disease affecting about 2% of the general population. Recently, treatments that specifically target key proinflammatory cytokines driving the disease have been developed to complement conventional therapies with unspecific antiproliferative or anti-inflammatory effects. Efficient monitoring of treatment efficacy in the context of precision medicine and the assessment of new therapeutics require accurate noninvasive readouts of disease progression. However, characterization of psoriasis treatment remains subjective based on visual and palpatory clinical assessment of features observed on the skin surface. We hypothesized that optoacoustic (photoacoustic) mesoscopy could offer label-free assessment of inflammation biomarkers, extracted from three-dimensional (3D) high-resolution images of the human skin, not attainable by other noninvasive methods. We developed a second-generation ultra-broadband optoacoustic mesoscopy system, featuring sub-10-μm resolution and advanced motion correction technology, and performed 80 longitudinal measurements of 20 psoriatic skin plaques in humans under conventional inpatient treatment or receiving biologics with concomitant topical corticosteroid treatment. Optoacoustic image analysis revealed inflammatory and morphological skin features that indicated treatment efficacy with sensitivity, accuracy, and precision that was not possible using clinical metrics. We identify 3D imaging biomarkers that reveal responses to treatment and offer the potential to facilitate disease and treatment characterization. Our findings suggest that optoacoustic mesoscopy may offer a method of choice for yielding both qualitative and quantitative evaluations of skin treatments that are inaccessible by other methods, potentially enabling optimized therapies and precision medicine in dermatology.
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Affiliation(s)
- Benedikt Hindelang
- Department of Dermatology and Allergy, Technical University of Munich, 81675 Munich, Germany.,Chair of Biological Imaging, Technical University of Munich, 81675 Munich, Germany.,Institute of Biological and Medical Imaging, Helmholtz Zentrum Munich, 85764, Neuherberg, Germany
| | - Teresa Nau
- Department of Dermatology and Allergy, Technical University of Munich, 81675 Munich, Germany.,Chair of Biological Imaging, Technical University of Munich, 81675 Munich, Germany.,Institute of Biological and Medical Imaging, Helmholtz Zentrum Munich, 85764, Neuherberg, Germany
| | - Ludwig Englert
- Chair of Biological Imaging, Technical University of Munich, 81675 Munich, Germany.,Institute of Biological and Medical Imaging, Helmholtz Zentrum Munich, 85764, Neuherberg, Germany
| | - Andrei Berezhnoi
- Chair of Biological Imaging, Technical University of Munich, 81675 Munich, Germany.,Institute of Biological and Medical Imaging, Helmholtz Zentrum Munich, 85764, Neuherberg, Germany
| | - Felix Lauffer
- Department of Dermatology and Allergy, Technical University of Munich, 81675 Munich, Germany
| | - Ulf Darsow
- Department of Dermatology and Allergy, Technical University of Munich, 81675 Munich, Germany
| | - Tilo Biedermann
- Department of Dermatology and Allergy, Technical University of Munich, 81675 Munich, Germany
| | - Kilian Eyerich
- Department of Dermatology and Allergy, Technical University of Munich, 81675 Munich, Germany
| | - Juan Aguirre
- Chair of Biological Imaging, Technical University of Munich, 81675 Munich, Germany.,Institute of Biological and Medical Imaging, Helmholtz Zentrum Munich, 85764, Neuherberg, Germany
| | - Vasilis Ntziachristos
- Chair of Biological Imaging, Technical University of Munich, 81675 Munich, Germany.,Institute of Biological and Medical Imaging, Helmholtz Zentrum Munich, 85764, Neuherberg, Germany.,Munich Institute of Robotics and Machine Intelligence (MIRMI), Technical University of Munich, 81675 Munich, Germany
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5
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Wang ZY, Fei WM, Li CX, Cui Y. Comparison of dermoscopy and reflectance confocal microscopy accuracy for the diagnosis of psoriasis and lichen planus. Skin Res Technol 2022; 28:480-486. [PMID: 35347763 PMCID: PMC9907646 DOI: 10.1111/srt.13158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/09/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Dermoscopy and reflectance confocal microscopy (RCM) as noninvasive tools are gaining increasing importance in the diagnosis of inflammatory skin disorders. The purpose of our study was to calculate and compare the diagnostic accuracy of dermoscopy and RCM in common inflammatory skin diseases. MATERIALS AND METHODS We retrospectively collected clinical, dermoscopic, and RCM images of psoriasis and lichen planuscases from March 2018 to February 2021 in China-Japan Friendship Hospital. There were 10 experts evaluated dermoscopic and RCM images independently. Sensitivity, specificity, positive predict value, and negative predictive value for each and all investigators were calculated. The diagnostic accuracy was also measured by the area under the curve (AUC) for the Receiver Operator Characteristic (ROC) Curves. RESULTS We collected 82 psoriasis and 47 lichen planus cases. Dermoscopy was more sensitive than RCM in the diagnosis of psoriasis, and overall diagnostic accuracy of dermoscopy was also higher than RCM measured by AUC (0.879 vs. 0.835, p = 0.0001). For lichen planus, RCM had higher sensitivity, specificity, positive predictive value, negative predictive value, and overall diagnostic accuracy than dermoscopy (AUC 0.916 vs. 0.813, p<0.0001). CONCLUSION Dermoscopy and RCM play a significant role in assisting the diagnosis of psoriasis and lichens planus. These two noninvasive diagnostic tools have their own advantages and disadvantages for the evaluation of different inflammatory skin diseases, and they can be combined in clinical practice to improve the accuracy of the diagnosis of inflammatory skin diseases.
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Affiliation(s)
- Zi-Yi Wang
- Department of Dermatology, China-Japan Friendship Hospital, Beijing, China.,Graduate School, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Wen-Min Fei
- Department of Dermatology, China-Japan Friendship Hospital, Beijing, China.,Graduate School, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Cheng-Xu Li
- Department of Dermatology, China-Japan Friendship Hospital, Beijing, China.,Graduate School, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yong Cui
- Department of Dermatology, China-Japan Friendship Hospital, Beijing, China.,Graduate School, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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Nailfold capillaroscopy in systemic diseases: short overview for internal medicine. ROMANIAN JOURNAL OF INTERNAL MEDICINE = REVUE ROUMAINE DE MÉDECINE INTERNE 2021; 59:201-217. [PMID: 33600677 DOI: 10.2478/rjim-2021-0007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Indexed: 11/20/2022]
Abstract
Nailfold capillaroscopy (NFC) is now one of the main imaging tools in systemic sclerosis and imposed over time as an easy, non-invasive method for the nailfold microvascular bed assessment. In qualitative NFC normal pattern is characterized by homogeneous, parallel fashion arrangement of the last capillaries row as well as by capillaries with hairpin or non-specific variations like tortuous and/ or crossing shape. Nailfold capillaroscopy is strongly recommended for evaluation of all patients with Raynaud phenomenon. Appearance of giant capillaries is chronologically the first relevant finding for scleroderma spectrum disorders development (systemic sclerosis, dermatomyositis, undifferentiated and mixed connective tissue disease). Collapses of the giant loops generate microhemorrhages and further capillary loss with subsequent hypoxia, and neoangiogenesis seen as ramified/ bushy capillaries. Nailfold capillaroscopy is indicated especially in systemic sclerosis, being also included in the classification criteria. Based on these major NFC pathologic findings (giant capillaries, microhemorrhages, avascularity and neoangiogenesis), three evolutive stages were described in systemic sclerosis, namely the early, active, and late scleroderma pattern. In other connective tissue diseases than those scleroderma-related, like systemic lupus erythematosus, psoriatic arthritis, or antiphospholipid syndrome, the interest for capillaroscopy is growing, but the attempts of defining specific characteristics failed until now. Besides qualitative NFC, semiquantitative and quantitative capillaroscopic assessments were proposed for more accurate evaluation. Lately, automated systems are under development. There is still need of more studies to sustain the nailfold capillaroscopy validity as diagnostic and prognostic test.
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7
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Accuracy of dermoscopic and reflectance confocal microscopic criteria for diagnosis of psoriasis. Chin Med J (Engl) 2020; 133:3010-3012. [PMID: 33337761 PMCID: PMC7752674 DOI: 10.1097/cm9.0000000000001198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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8
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Golińska J, Sar‐Pomian M, Rudnicka L. Dermoscopy of plaque psoriasis differs with plaque location, its duration, and patient's sex. Skin Res Technol 2020; 27:217-226. [DOI: 10.1111/srt.12933] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/18/2020] [Accepted: 06/25/2020] [Indexed: 01/06/2023]
Affiliation(s)
- Joanna Golińska
- Department of Dermatology Medical University of Warsaw Warsaw Poland
| | - Marta Sar‐Pomian
- Department of Dermatology Medical University of Warsaw Warsaw Poland
| | - Lidia Rudnicka
- Department of Dermatology Medical University of Warsaw Warsaw Poland
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9
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Zheng X, Wu C, Jin H, Liu J, Wang H. Investigation of using very high-frequency ultrasound in the differential diagnosis of early-stage pemphigus vulgaris vs seborrheic dermatitis. Skin Res Technol 2020; 26:476-481. [PMID: 31930604 PMCID: PMC7496295 DOI: 10.1111/srt.12836] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 12/18/2019] [Indexed: 12/05/2022]
Abstract
Background Early‐stage pemphigus vulgaris (PV) often manifests as erythema alone. We hypothesized that very high‐frequency ultrasonography (VHFUS) features could simplify the differential diagnosis of early‐stage pemphigus vulgaris versus seborrheic dermatitis (SD). Materials and Methods Fourteen patients with SD or early‐stage PV were recruited from our outpatient clinic during 2016‐2019. We used 50‐MHz VHFUS to image the erythema on the patients’ scalp, face, chest, and back and retrospectively evaluated their ultrasonographic features. Results Very high‐frequency ultrasonography images of early‐stage PV showed enhanced epidermal echo (8/14, 57%), linear or oval intra‐epidermal hypoechoic/anechoic areas (12/14, 86%), linear anechoic areas at the dermal‐epidermal junction (14/14, 100%), reduced echo of superficial to whole dermis (9/14, 64%), and slightly increased dermal thickness (14/14, 100%). The intra‐epidermal hypoechoic/anechoic bands (100%) showed the greatest specificity. VHFUS images of SD showed enhanced epidermal echo (7/14, 50%), epidermal unevenness (7/14, 50%), linear anechoic bands at the dermal‐epidermal junction (8/14, 57%), reduced middle dermis echo (10/14, 71%), and slightly increased dermal thickness (10/14, 71%). The epidermal unevenness (100%) had the greatest specificity. There was a significant difference (P < .05) between early‐stage PV and SD regarding the proportion of linear intraepithelial hypoechoic/anechoic bands and linear anechoic areas at the dermal‐epidermal junction. Conclusions Early‐stage PV and SD have relatively specific VHFUS erythematous manifestations. Intra‐epidermal hypoechoic/anechoic bands for early‐stage PV and epidermal unevenness for SD were most specific. VHFUS contributes to the differential diagnosis of PV and SD by highlighting their features, that is, intra‐epidermal hypoechoic/anechoic bands and linear anechoic areas at the dermal‐epidermal junction.
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Affiliation(s)
- Xiaofeng Zheng
- Department of Dermatology, Peking Union Medical College Hospital, Beijing Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Chao Wu
- Department of Dermatology, Peking Union Medical College Hospital, Beijing Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Hongzhong Jin
- Department of Dermatology, Peking Union Medical College Hospital, Beijing Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jie Liu
- Department of Dermatology, Peking Union Medical College Hospital, Beijing Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Haimeng Wang
- Department of Dermatology, Peking Union Medical College Hospital, Beijing Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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10
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Golińska J, Sar‐Pomian M, Rudnicka L. Dermoscopic features of psoriasis of the skin, scalp and nails – a systematic review. J Eur Acad Dermatol Venereol 2019; 33:648-660. [DOI: 10.1111/jdv.15344] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 10/01/2018] [Indexed: 12/11/2022]
Affiliation(s)
- J. Golińska
- Department of Dermatology Medical University of Warsaw Warsaw Poland
| | - M. Sar‐Pomian
- Department of Dermatology Medical University of Warsaw Warsaw Poland
| | - L. Rudnicka
- Department of Dermatology Medical University of Warsaw Warsaw Poland
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11
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Lacarrubba F, Ardigò M, Di Stefani A, Verzì AE, Micali G. Dermatoscopy and Reflectance Confocal Microscopy Correlations in Nonmelanocytic Disorders. Dermatol Clin 2018; 36:487-501. [PMID: 30201157 DOI: 10.1016/j.det.2018.05.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Dermatoscopy and in vivo reflectance confocal microscopy are noninvasive techniques that provide a horizontal approach, with an en face view of the skin structures. Both techniques assist in the clinical diagnosis of a variety of inflammatory and infectious cutaneous disorders. In many cases, they have shown concordance. Their combined use represents, in several instances, a promising option to reach the final diagnosis without the need for invasive procedures.
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Affiliation(s)
- Francesco Lacarrubba
- Dermatology Clinic, University of Catania, Via Santa Sofia 78, Catania 95123, Italy.
| | - Marco Ardigò
- Department of Clinical Dermatology, San Gallicano Dermatological Institute, Rome, Italy
| | | | - Anna Elisa Verzì
- Dermatology Clinic, University of Catania, Via Santa Sofia 78, Catania 95123, Italy
| | - Giuseppe Micali
- Dermatology Clinic, University of Catania, Via Santa Sofia 78, Catania 95123, Italy
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12
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Micali G, Lacarrubba F, Santagati C, Egan CG, Nasca MR, Musumeci ML. Clinical, ultrasound, and videodermatoscopy monitoring of psoriatic patients following biological treatment. Skin Res Technol 2015; 22:341-8. [PMID: 26450445 DOI: 10.1111/srt.12271] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2015] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND PURPOSE Effective non-invasive techniques to monitor plaque psoriasis progression and treatment are desirable. The aim of the study was to evaluate changes in vascular pattern using videodermatoscopy (VD) and in skin thickness by ultrasound (US), along with clinical observation, during treatment with biologicals. METHODS Forty-two patients with moderate-to-severe plaque psoriasis treated with adalimumab, etanercept, or ustekinumab were evaluated. Following the identification of a 'target' plaque at baseline, lesion changes were monitored at 15, 30 and 60 days by clinical observation using a Target Lesion Score (TLS), and by VD and US. RESULTS After 60 days, a significant improvement in all three parameters was observed. In adalimumab-treated patients mean values of TLS, VD, and US were reduced by 83.9%, 73.5%, and 90%, respectively; in etanercept-treated patients by 67.9%, 49.7%, and 79.3%; in ustekinumab-treated patients by 80.9%, 66.4%, and 80.1%. Skin thickness was the first parameter to improve. Vascular improvement was slower compared to clinical and US responses. CONCLUSION VD and US may be useful to monitor psoriasis treatment. Further investigations are warranted to assess if the persistence of an altered vascular pattern despite clinical and US normalization, as observed in 22% of patients, may influence disease progression and/or correlate with rate and severity degree of relapse.
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Affiliation(s)
- G Micali
- Dermatology Clinic, University of Catania, Catania, Italy
| | - F Lacarrubba
- Dermatology Clinic, University of Catania, Catania, Italy
| | - C Santagati
- Dermatology Clinic, University of Catania, Catania, Italy
| | - C G Egan
- Primula Multimedia SRL, Pisa, Italy
| | - M R Nasca
- Dermatology Clinic, University of Catania, Catania, Italy
| | - M L Musumeci
- Dermatology Clinic, University of Catania, Catania, Italy
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13
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Lacarrubba F, Pellacani G, Gurgone S, Verzì AE, Micali G. Advances in non-invasive techniques as aids to the diagnosis and monitoring of therapeutic response in plaque psoriasis: a review. Int J Dermatol 2015; 54:626-34. [PMID: 25772034 DOI: 10.1111/ijd.12870] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 08/07/2014] [Accepted: 09/14/2014] [Indexed: 11/30/2022]
Abstract
Plaque psoriasis is a common, chronic, inflammatory disease with a multifactorial etiopathogenesis. Although its diagnosis is often based on clinical features, in ambiguous cases a biopsy with histopathologic confirmation may be necessary. Advanced high-definition imaging techniques may be useful in the study of skin properties in vivo and may facilitate therapeutic monitoring. Available imaging tools vary in their resolution, depth of penetration and visual representation (horizontal, vertical, three-dimensional), and in the type of skin structures visualized. The purpose of this review is to analyze a variety of non-invasive techniques that may assist in establishing definitive diagnoses, as well as in the therapeutic monitoring of psoriasis. These include dermoscopy, videocapillaroscopy (VC), high-frequency ultrasound (HFUS), reflectance confocal microscopy (RCM), laser Doppler imaging (LDI), optical coherence tomography (OCT), optical microangiography (OMAG) and multiphoton tomography (MPT). Their characteristics, indications, advantages, and limits are reviewed and discussed. Dermoscopy may be useful for a first, rapid outpatient evaluation. Videocapillaroscopy and HFUS represent the imaging techniques with the longest history of use in psoriasis. However, whereas VC is useful in both diagnosis and therapeutic monitoring, the utility of HFUS appears to be limited to the monitoring of response to therapy only. Both devices are cost-effective and easy to use in the office setting. Both RCM and OCT allow high-resolution microscopic imaging of psoriatic plaque in a manner comparable with that of virtual histopathology and represent more promising techniques. The utility of LDI, OMAG, and MPT in psoriasis skin imaging requires further study and validation.
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Affiliation(s)
| | - Giovanni Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Silvia Gurgone
- Department of Dermatology, University of Catania, Catania, Italy
| | - Anna Elisa Verzì
- Department of Dermatology, University of Catania, Catania, Italy
| | - Giuseppe Micali
- Department of Dermatology, University of Catania, Catania, Italy
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14
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Lacarrubba F, Musumeci M, Ferraro S, Stinco G, Verzì A, Micali G. A three-cohort comparison with videodermatoscopic evidence of the distinct homogeneous bushy capillary microvascular pattern in psoriasis vs atopic dermatitis and contact dermatitis. J Eur Acad Dermatol Venereol 2015; 30:701-3. [DOI: 10.1111/jdv.12998] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- F. Lacarrubba
- Dermatology Clinic; University of Catania; Catania Italy
| | - M.L. Musumeci
- Dermatology Clinic; University of Catania; Catania Italy
| | - S. Ferraro
- Dermatology Clinic; University of Catania; Catania Italy
| | - G. Stinco
- Department of Experimental and Clinical Medicine; Institute of Dermatology; University of Udine; Gemona del Friuli Italy
| | - A.E. Verzì
- Dermatology Clinic; University of Catania; Catania Italy
| | - G. Micali
- Dermatology Clinic; University of Catania; Catania Italy
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