Videocapillaroscopy in the Differential Diagnosis between Psoriasis and Seborrheic Dermatitis of the Scalp

Abstract

Background: Videocapillaroscopy (VCP) can be used to explore microcirculatory modifications in skin diseases. Psoriasis shows specific capillary alterations reflecting typical histopathological changes. Objective: To compare capillary morphology, distribution and density in psoriasis and seborrheic dermatitis of the scalp for differential diagnosis. Methods: VCP was performed on histology-confirmed scalp lesions of 30 patients with chronic plaque psoriasis, 30 age- and sex-matched patients with seborrheic dermatitis and 30 healthy subjects. The morphology, mean density per mm² and mean diameter of capillary loops was measured. Results: Scalp psoriasis exhibited homogeneously tortuous and dilated capillaries (bushy pattern), with a 73 ± 17 µm (mean ± standard deviation) diameter of capillary bushes. In contrast, scalp seborrheic dermatitis presented a multiform pattern, with mildly tortuous capillary loops and isolated dilated capillaries, but a substantial preservation of local microangioarchitecture. Mean diameter of capillary bush was significantly lower (27 ± 4 µm; p < 0.001) and similar to that of the scalp of healthy subjects (21 ± 5 µm). Capillary loop density was similar in patients with psoriasis (23 ± 5/mm²) seborrheic dermatitis (24 ± 2/mm²) and healthy scalp skin (24 ± 3/mm²). Conclusion: VCP could be a useful noninvasive approach for differentiating between psoriasis and seborrheic dermatitis, especially when the scalp is the only affected site.

Combined Clinical, Capillaroscopic and Ultrasound Evaluation during Treatment of Plaque Psoriasis with Oral Cyclosporine

“…In recent years, both dermatoscopy and YO have been shown to be useful for differential diagnosis, prognostic evaluation, and monitoring response to treatment in a range of dermatological disorders, including psoriasis (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). Although a few studies have monitored response to treatment by YO (or videocapillaroscopy) in patients with plaque psoriasis (8,(15)(16)(17), to our knowledge, only one previous study has used this technique to monitor improvement in plaque psoriasis following Cs treatment (5).…”

Dermoscopic findings in psoriasis and seborrheic dermatitis on the scalp and correlation with disease severity

“…Videodermoscopic observations of psoriasis lesions on the scalp often reveal interfollicular twisted loops, which are seen as red dots/globules at lower magnifications and as polymorphous beaded circles at higher magnifications when the probe is positioned vertically on the scalp [15]. These vascular structures correspond to elongated, dilated capillaries in the dermal papilla and seem to correlate with disease activity [15][16][17]. Kim et al [18] used the term "glomerular vessels" for these dilated capillaries.…”

“…Biopsy may be needed; even so, there are times when histopathological investigation can be inadequate for diagnosis. Dermoscopic examinations of psoriasis and seborrheic dermatitis lesions yielded different morphologies especially in the microvascular structures so it can be useful in differentiating these diseases [10][11][12][13][14][15][16][17][18][19]. In this study we investigated the usefulness of dermoscopy in the clinical differentiation of psoriasis and seborrheic dermatitis on the scalp and as distinct from previous studies, we also evaluated correlation of dermoscopic findings with disease severity.…”

Trichoscopy

“…Bu muayene yönteminde damarsal paterne bakılması sıklıkla seboreik dermatit ve psoriasis gibi inflamatuvar saçlı deri hastalıklarının ayırıcı tanısında yardımcı olmakla beraber, saç hastalıkları tanısında yol gösterici değildirler (27,28). Normal bir saçlı derinin muayenesinde damarsal yapılardan interfoliküler basit kırmızı düğümler ve dallanan hatlar görülebilir.…”