Combined Clinical, Capillaroscopic and Ultrasound Evaluation during Treatment of Plaque Psoriasis with Oral Cyclosporine

Abstract

Imaging techniques have only recently been utilized in combination with clinical observation to objectively quantify psoriasis severity and evaluate therapeutic response. This study evaluated the sensitivity of videodermatoscopy (VO) and ultrasound (US) imaging to assess the therapeutic effect of cyclosporine (Cs) in patients with moderate-to-severe psoriasis. Twenty patients with moderate-tosevere psoriasis were divided into two groups (A and B) based on PASI score. Group A (PASI >16) was treated with 5 mg/Kg/day Cs for 4 weeks and another 4 weeks with 3 mg/Kg/day Cs. Group B (PASI 10-16) received 3 mg/Kg/day Cs for 8 weeks. A "target" plaque was selected for each subject and evaluated using a Target Lesion Score (TLS) for erythema, scaling and degree of infiltration, in addition to VO and US at baseline, 2, 4 and 8 weeks. At the end of the study, improvement rate was quicker in group A vs group B after 8 weeks of Cs therapy. All three parameters (TLS, VO and US) strongly correlated with one another. Skin thickness was the first parameter that improved, followed by TLS. In contrast, improvement in VO was delayed. Normalization rate of vascular pattern (assessed by VO) was low in both groups but higher in group A vs group B (46% vs 22%), despite virtually complete normalization by clinical and US assessment. In conclusion, while both TLS and US can be utilized in the evaluation of therapeutic efficacy in patients with plaque psoriasis, VO can provide information on vascular response to treatment, which may likely affect the duration of therapy and the relapse rates.

Clinical, ultrasound, and videodermatoscopy monitoring of psoriatic patients following biological treatment

“…In the remaining 4 (22%), 2 treated with etanercept, one each with adalimumab and ustekinumab, a 'bushy' vascular pattern persisted; none of these patients was affected by concomitant psoriatic arthritis. Our findings are in agreement with previous studies in which microvascular improvement as detected by VD or VCP was substantially lower than the clinical response, supporting the view that normalization of microcirculation pattern in psoriasis is not achieved by all patients (11,19,21,23). However, as we used standard dosages per drug, it cannot be excluded that increasing doses could provide better outcome.…”

“…The results obtained in this study are in agreement with data of a previous study of 20 psoriatic subjects (13M/7F; age range 18-70 years) treated with cyclosporine (3-5 mg/ kg/day) and evaluated using the same imaging methodologies (19). In the examined 'target' lesions, the improvement in TLS, VD and US mean values after 60 days of treatment were 87.4%, 61.4%, and 91.3%, respectively.…”

“…Some studies have shown the potential use of these diagnostic tools to assess treatment outcomes following various topical (20,22) or systemic treatments such as cyclosporine (19,21), acitretin (23) (11). In regard to the use of US for treatment monitoring of psoriasis, several studies are available (19,25,26). However, to our knowledge, our study is the first to combine VD and US along with clinical evaluation to monitor biological treatment efficacy.…”

Application of Photoacoustic Methods and Confocal Microscopy for Monitoring of Therapeutic Response in Plaque Psoriasis

“…It is not precisely known if these vascular changes are related only to the loop structure or to the whole volume of the capillaries. Persistent capillary changes are supposed to promote relapses in spite of superficial healing of the skin lesion [38,39]. In this study, the average vessel diameter and the percentage vasculature per unit volume was represented in a skin area of maximally 9.6 × 9.6 mm using a photoacoustic system.…”

Ultrasonography in psoriatic disease

“…Ultrasonography in association with clinical examination was reported as useful in evaluating the therapeutic efficacy of oral cyclosporine in 20 patients with plaque psoriasis, the capillaroscopic vascular response being monitored through videodermatoscopy in order to detect early relapsing signs [32].…”