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

Abstract

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.

A prospective randomized half-body study: 308 nm LED light vs. 308 nm excimer laser for localized psoriasis

“…Dermoscopy can provide detailed visualization of key dermatoscopic features, allowing for the identification of subtle changes, and provides a more accurate evaluation of the treatment response (13). Changes in the vessel patterns were reported to be a predictor of the response of psoriatic patients to phototherapy (14). In both treatment sides, we observed similar vascular changes, implying a comparable mechanism of action for both types of light.…”

Clinical value of dermoscopy in psoriasis

“…In recent years, several studies have shown that there is a correlation between the treatment outcome of psoriasis and the specific dermoscopic features, such as the hemorrhagic dots and blood vessel diameter, which makes dermoscopic features a potential predictor of the curative effect on psoriasis 74,78,79 …”

“…The two look similar under handheld dermoscopy, 81 thus earlier studies did not consider the classification of dotted vessels by diameter to be of diagnostic significance 82 . However, recent studies have shown that the globular vessels are associated with treatment resistance, while the dotted vessels predict better treatment outcomes in local treatments, such as calcipotriene plus betamethasone dipropionate aerosol foam, narrowband ultraviolet B phototherapy, and 650‐microsecond 1064‐nm Nd:YAG laser 70,78,79 . Several studies have found that globular vessels are more likely to be observed in the legs, where the dotted vessels appear less frequently than in other parts of the body 12,70,79 .…”

“…In recent years, several studies have shown that there is a correlation between the treatment outcome of psoriasis and the specific dermoscopic features, such as the hemorrhagic dots and blood vessel diameter, which makes dermoscopic features a potential predictor of the curative effect on psoriasis. 74,78,79 Under dermoscopy, the dotted vessels appear as densely packed punctate structures, while globular vessels are a special type of dotted vessel that appear as twisted vessels distributed in clusters, resembling glomeruli, 80 with a diameter larger than that of dotted vessels. The two look similar under handheld dermoscopy, 81 thus earlier studies did not consider the classification of dotted vessels by diameter to be of diagnostic significance.…”

“…82 However, recent studies have shown that the globular vessels are associated with treatment resistance, while the dotted vessels predict better treatment outcomes in local treatments, such as calcipotriene plus betamethasone dipropionate aerosol foam, narrowband ultraviolet B phototherapy, and 650-microsecond 1064-nm Nd:YAG laser. 70,78,79 Several studies have found that globular vessels are more likely to be observed in the legs, where the dotted vessels appear less frequently than in other parts of the body. 12,70,79 May be due to a higher hydrostatic pressure due to microcirculation impairment in the legs, which leads to an increase in vessel permeability and consequent formation of a fibrin cuff around the capillaries, leading to tissue hypoxia and the release of inflammatory mediators.…”