Can Dermoscopy and Ultrasonography be Considered a Prognostic Tool in Management of Psoriasis?

Abstract

Background: Dermoscopy can reliably predict the diagnosis of plaque psoriasis. Ultrasonography has been increasingly used in dermatology in inflammatory diseases like psoriasis as a tool for evaluation. Hence, this study was done to evaluate the role of dermoscopy and ultrasonography as prognostic aid in plaque psoriasis. Aims and Objectives: To study the sonographic and dermoscopic findings of clinically diagnosed psoriatic lesions and the changes in the psoriatic lesions if any, with the treatment. How these findings can be utilized to assess the prognosis in these patients. Materials and Methods: The present study comprised 50 patients with clinically diagnosed plaque psoriasis. Lesions were assessed with Dino-Lite digital microscope AM7515MZT, followed by ultrasonography using a 15 MHz probe, and findings were recorded. All the patients included in this study were given appropriate treatment (topical/systemic) for 6 weeks and were followed up twice i.e., at 3 weeks and 6 weeks after initiating treatment. Results: Whitish scales were the most common scale color seen in our study seen in 35/50 patients (70%). All the vascular structures were reddish, red dots and globules being the predominant type and with the improvement of the lesions, brown structures increased. A total of 28 (56%) patients had a regular pattern of vessel arrangement. Mean capillary size was 0.097 ± 0.012 mm that reduced to 0.075 ± 0.019 mm at the end of the third week and 0.027 ± 0.032 mm at the end of 6 weeks. In ultrasonographic assessment, mean epidermal thickness reduced from 0.1008 to 0.0764 cm at third week and 0.068 cm at the sixth week, and mean dermal thickness reduced from 0.2692cm to 0.1906cm at the third week and then to 0.1906cm 0.1806cm at the sixth week. In our study, clinical improvement preceded dermoscopic improvement. Newer structures identified in the study are a perifollicular arrangement of capillaries and the presence of lacunar structures in the healing lesions. Conclusion: The scale distribution, capillary number, and capillary size in dermoscopic assessment, and epidermal and dermal thickness in ultrasonography showed statistically significant changes with treatment and thus may be taken as the prognostic indicators. Thus, both these noninvasive modalities may be useful in the therapeutic monitoring of plaque psoriasis.

Clinical value of dermoscopy in psoriasis

“…[69][70][71] Moreover, the distribution density of the dotted/ globular vessels decreased gradually until there was a partial return to normal. 72,73 The clinical symptom score shown a significant correlation with the diameter of the glomus observed under dermoscopy, 74 which suggested that the changes in the vascular pattern in the skin lesions may be used as an index to observe the effect of psoriasis treatment and the recovery of skin lesions.…”

“…The dynamic observation of patients with psoriasis who had been cured, showed that, with the improvement of clinical symptoms, the diameter of the dilated glomus under dermoscopy decreased gradually 69–71 . Moreover, the distribution density of the dotted/globular vessels decreased gradually until there was a partial return to normal 72,73 . The clinical symptom score shown a significant correlation with the diameter of the glomus observed under dermoscopy, 74 which suggested that the changes in the vascular pattern in the skin lesions may be used as an index to observe the effect of psoriasis treatment and the recovery of skin lesions.…”

Dermoscopy in the diagnosis of selected inflammatory dermatoses

“…Łuszczyca to ogólnoustrojowa choroba zapalna skóry o przewlekłym charakterze, której manifestacje skórne są efektem hiperproliferacji naskórka [10]. Postawienie diagnozy następuje zwykle na podstawie introduction Dermoscopy, also known as epiluminescence microscopy, is a non-invasive technique for imaging melanocytic lesions commonly used in the diagnosis of skin cancers [1,2].…”

“…Therefore, dermoscopy seems to be an effective and quick examination facilitating the diagnosis without the need to perform a skin biopsy, which is a procedure that generates additional costs and causes discomfort to patients [9]. psoriAsis Psoriasis is a systemic, inflammatory skin disease of a chronic nature, skin manifestations of which are the result of hyperproliferation of the epidermis [10]. The diagnosis is usually made on the basis of the clinical picture, i.e., red papules and silvery scales, however, dermoscopy is a useful complementary examination [7,10].…”

“…psoriAsis Psoriasis is a systemic, inflammatory skin disease of a chronic nature, skin manifestations of which are the result of hyperproliferation of the epidermis [10]. The diagnosis is usually made on the basis of the clinical picture, i.e., red papules and silvery scales, however, dermoscopy is a useful complementary examination [7,10].…”