Dermoscopic hemorrhagic dots: an early predictor of response of psoriasis to biologic agents

Abstract

BackgroundBiologic agents are routinely used in the treatment of severe psoriasis. The evaluation of treatment response is mainly based on the physician’s global clinical assessment.ObjectiveTo investigate whether dermoscopy might enhance the assessment of response of psoriasis to treatment with biologic agents.MethodsPatients with severe psoriasis scheduled to receive a biologic agent were enrolled in the study. A target lesion from each patient was clinically and dermoscopically documented at baseline and after one, two and six months. The clinical response was evaluated by the recruiting clinicians at all visits, while dermoscopic images were evaluated by two independent investigators, blinded to the clinical information. Chi Square test was used for cross-tabulation comparisons, while odds ratios, 95% confidence intervals and p values were calculated using univariate logistic regression.ResultsOverall, there was a significant correlation between clinical response and vessel distribution at all time points: a regular vessel distribution correlated with no response, a clustered distribution with partial response, and the dermoscopic absence of vessels with complete response. The presence of dermoscopic hemorrhagic dots was a potent predictor of favorable clinical response at the subsequent visit at all time points. Among lesions initially clinically responding and later recurring, 87.5% displayed dermoscopic dotted vessels despite the macroscopic remission.ConclusionDermoscopy might be a useful additional tool for evaluating the response of psoriatic patients to biologic agents. Hemorrhagic dots represent an early predictor of clinical response, while the persistence or reappearance of dotted vessels might predict clinical persistence or recurrence, respectively.

Dermoscopic features of psoriasis of the skin, scalp and nails – a systematic review

“…Also, the efficacy of therapy with biologics, with a good prognostic factor of purpuric dots, cyclosporine and long-term therapy with potent steroids, with patterns that indicate the overuse, was monitored by dermoscopy. 11,14,16,[19][20][21][22]56 While revising the literature, the authors noted the need of terminology unification which is subjective in terms, especially as regards studies concerning onychoscopic features of psoriasis. Further limitations of the present study were lack of histological confirmation of the disease in many cases and too small samples in some studies; moreover, the use of different dermoscopes may have influenced the results.…”

“…The nomenclature was not unified in the studies. 10,11 The most common pattern of vessel distribution observed in 77.4% (388/501) psoriatic plaques was 'regular', described also as 'diffuse' and 'homogenous'. Data on the vascular patterns mentioned above and the other patterns described in the literature as well as their dermoscopic appearance are presented in Table 1 and Figure 2.…”

“…7 Haemorrhages/ulcerations were observed in 11/100 (11%) psoriatic plaques by Pan et al 5 Kn€ opfel et al 29 published a case report, in which extravasations in psoriatic plaques on the buttocks visible in dermoscopy were named 'Auspitz sign in the scale'. Lallas et al 11 reported on the purpuric dots as a dermoscopic sign indicative of a good response to biological treatment with adalimumab, infliximab, etanercept, ustekinumab in plaque psoriasis.…”

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

“…for dermoscopic examination); such two assessments were blinded to each other. Regarding clinical evaluation, we calculated local psoriasis severity index (LPSI) (which is the sum of severity of erythema, scaling/desquamation, and induration/infiltration on a 5‐point scale [0 to 4], with a total score ranging from 0 to 12), while, from a dermoscopic point of view, we investigated the presence of several variables which were selected according to literature data (i.e. dotted vessels [regularly distributed, clustered, or sparse], globular vessels [regularly distributed, clustered, or sparse], non‐dotted/non‐globular vessels [regularly distributed, clustered, or sparse], white scales [diffusely distributed, patchily distributed, sparse, central or peripheral], yellow scales [diffusely distributed, patchily distributed, sparse, central or peripheral], hemorrhagic spots, hypopigmented areas, and pigmentation structures [brown reticular areas, brown dots/globules, and “discolored areas”]).…”

“…In this regard, psoriasis is the condition having the strongest supportive evidence, with the combination of regularly distributed dotted vessels and diffuse white scaling being a highly specific clue for its diagnosis . Moreover, a recent study has demonstrated that dermoscopic examination may also be of aid in predicting clinical response of psoriasis vulgaris, with purpuric dots being an early positive predictor of response in patients treated with biologic agents …”