Relationship between Histological and Clinical Course of Psoriasis: A Pilot Investigation by Reflectance Confocal Microscopy during Goeckerman Treatment

Abstract

Alterations of the skin microvasculature are known to play an important role in the development and maintenance of psoriatic skin lesions. In this study, we investigated lesional skin in 11 psoriatic patients during a modified Goeckerman treatment using reflectance confocal microscopy (RCM) to study the relationship between clinical clearance and histological normalization of psoriatic skin and the significance of histological abnormalities on the course of disease. The treatment regimen resulted in a significant reduction of the Psoriasis Area and Severity Index (PASI) as well as capillary and papillary diameters (p < 0.0001). The capillary and papillary diameters were still enlarged when compared to those in normal skin (p < 0.001). Capillary and papillary diameters correlated with each other prior to and after treatment (correlation coefficient = 0.63 and 0.64, p = 0.01 and 0.002, respectively) but not with the PASI. Capillary and papillary diameters after treatment and percentage reduction of the PASI during treatment seemed to be better predictors for the clinical course of relapse than the PASI after treatment. These findings make the subclinical changes of psoriatic skin vessels and dermal papillae a legitimate target for treatment. Further investigations of a large group of patients are needed to evaluate the potential of RCM findings as successor of the PASI in the monitoring of psoriasis.

Evaluation of ICAM‐1 expression and vascular changes in the skin of patients with plaque, pustular, and erythrodermic psoriasis

“…demonstrated that capillaries in expanded psoriatic plaques are responsible for the migration of activated T lymphocytes to the lesions, directly influencing their maintenance and severity . The resolution of vascular changes is mentioned as one of the main parameters for evolution of clinical improvement . Few studies have evaluated vascular alterations on the psoriatic plaque and, to the best of our knowledge, there are no studies analyzing these factors in erythrodermic and pustular forms nor comparing the three forms of psoriasis.…”

Two-photon autofluorescence lifetime imaging of human skin papillary dermis in vivo: assessment of blood capillaries and structural proteins localization

“…This network is controlled by numerous mechanisms, and there are many ways in which such a delicate system may break down, leading to cardiovascular disease. The structure of capillaries can also be influenced by dermal diseases such as psoriasis 6–8 . Skin capillaries can be observed using standard optical microscopy 9 .…”

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

“…This discrepancy could be due to the fact that our psoriatic were examined during therapy, whereas Archid et al [42] included only patients into their study who had not received any anti-psoriatic therapy in the 2 months prior to the study. Interestingly, a further investigation conducted by Archid et al [42] on 11 patients showed that, in terms of the percentage reduction of the Psoriasis Area Severity Index value, a clinical improvement under Goeckerman therapy correlated with a normalization of the papillary structure rather than of the capillaries [42]. Another study performed by Ardigo et al [43] showed separate tendencies in the microscopic changes during the administration of 2 local therapeutics of different effects.…”