Assessment of dermal papillary and microvascular parameters in psoriasis vulgaris using in�vivo reflectance confocal microscopy

Abstract

In vivo reflectance confocal microscopy (RCM) is a modern, non-invasive imaging technique, which allows for real-time examination of the upper layers of the skin at a resolution similar to that of classic microscopy. In addition, it has the advantage of real-time evaluation of blood flow and dynamic monitoring of cutaneous changes while preserving tissue integrity. The present study reported on the in vivo RCM technique as an objective method for the noninvasive assessment of psoriasis vulgaris that is potentially applicable in clinical studies and in monitoring the evolution of lesions under treatment. In psoriasis lesions, RCM virtual horizontal sections at the level of the dermo-epidermal junction featured numerous and prominent dermal papillae that were not surrounded by bright rings of basal cells. Micromorphological examination of the lesions using this technique revealed that mean values of the section area, the perimeter and the Feret's diameter of the dermal papillae were significantly higher in psoriatic lesions than in normal skin. An increased number of capillary vessels per lesional dermal papilla as compared to healthy skin was observed. Furthermore, micromorphological parameters of dermal capillaries were increased in psoriatic skin. These observations point to the utility of in vivo RCM as a promising technique for the non-invasive diagnosis of psoriasis vulgaris, for monitoring the evolution of lesions at a micromorphological level under various treatments and for gaining a better understanding of the pathophysiological processes that occur in the evolution of this disease.

Systematic review and proposal of an in vivo reflectance confocal microscopy assessment tool for cutaneous lymphoma

“…In the dermis, the most evident feature is dermal blood vessel dilatation, which appears to be observed in some of the CTCL cases. Blood vessel dilatation has been also described in psoriasis and the parameters of the dermal papillae and blood vessels have been established for this inflammatory condition but it has not been measured in MF lesions or any other inflammatory conditions except for psoriasis.…”

The first nation-wide study revealing epidemiologic data and life quality aspects of psoriasis in Romania

“…Psoriasis is an immune-mediated disease (1), with cutaneous and systemic manifestations and substantial negative effects on the patients' quality of life. It showcases a complex etiopathogenesis, occurring through inflammation and epidermal hyperproliferation (2)(3)(4). As described in literature, it has a hereditary component, requiring an association of genetic factors such as the involvement of HLA-Cw6-now known as the psoriasis susceptibility locus 1 (PSORS1) (2), as well as polymorphic variants of interleukins (5,6) and environmental triggers such as cigarette smoke (7,8), stress (9), western type diets (6)(7)(8) to become manifest.…”

The challenge of diagnosing seborrheic keratosis by reflectance confocal microscopy

“…The contrast is provided by differences in the refractive index and size of different cellular organelles as well as the extracellular microstructures within the tissue . RCM is a novel non‐invasive, real‐time, and repeatable diagnostic tool that has recently been applied for the evaluation of various skin diseases, including seborrheic keratosis, actinic keratosis, nevus, basal cell carcinoma, verruca plana, and psoriasis …”

“…5 RCM is a novel non-invasive, real-time, and repeatable diagnostic tool that has recently been applied for the evaluation of various skin diseases, including seborrheic keratosis, actinic keratosis, nevus, basal cell carcinoma, verruca plana, and psoriasis. 3,4,[6][7][8][9] At present, the reported RCM criteria of SK include cerebriform surface structures, 10,11 keratin-filled invaginations, corneal pseudocysts, and a regular honeycomb pattern 12 at epidermal layers; cords, 12,13 densely packed round to polymorphous and wellcircumscribed dermal papillae 4,11 at the dermo-epidermal junction;…”