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In vivo quantification of the structural abnormalities in psoriatic microvessels before and after pulsed dye laser treatment.
Br J Dermatol. 2005 Mar; 152(3):505-11.BJ

Abstract

BACKGROUND

Microvascular abnormalities (capillary elongation, widening and tortuosity) are a characteristic feature of psoriasis and form one of the pathological diagnostic criteria. These changes occur early in the progression of a psoriatic plaque, before there is clinical or histological evidence of epidermal hyperplasia. Treatment of psoriatic microvessels with a pulsed dye laser (PDL) has been associated with both clinical improvement and clearance of lesions.

OBJECTIVES

To quantify the structural vascular abnormalities in plaque skin using noninvasive techniques in vivo. Investigations were carried out before and after PDL treatment to determine the nature of laser-induced microvascular changes and the relationship between these changes and clinical improvement.

METHODS

Plaque microvessels were visualized using native capillaroscopy. Plaques were then treated three times with the PDL at 14-day intervals. Native capillaroscopy was repeated at 2 and 6 weeks after the final laser treatment. Images were analysed using a combination of nonstereological and stereological measurements.

RESULTS

Whole body disease was stable. Treated plaques showed a 48% reduction in plaque severity score (P < 0.01). Native studies showed that the PDL significantly reduced plaque microvessel density (P < 0.05), image area fraction (P < 0.01), microvessel length density (P < 0.01) and vessel image width (P < 0.01). The reduction in plaque severity score (which denoted clinical improvement) was related quantitatively to the reduction in microvessel area per unit area of plaque skin, i.e. the image area fraction (correlation coefficient = 0.772, P < 0.01). The greatest response of plaque microvessels was within 2 weeks after the final laser treatment, while the greatest reduction in plaque severity score occurred between 2 and 6 weeks after the final laser treatment, i.e. clinical improvement was preceded by microvascular improvement.

CONCLUSIONS

These findings indicate that there is a close correlation between the state of the superficial vasculature and the clinical status of psoriasis. The expanded superficial microvascular bed in plaque skin is a necessary component for maintaining clinical lesions and these blood vessels are thus a legitimate target for treatment.

Authors+Show Affiliations

Cardiac and Vascular Sciences, St George's Hospital Medical School, Cranmer Terrace, London, SW17 0RE, UK. jonathan@dhern.freeserve.co.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15787819

Citation

Hern, S, et al. "In Vivo Quantification of the Structural Abnormalities in Psoriatic Microvessels Before and After Pulsed Dye Laser Treatment." The British Journal of Dermatology, vol. 152, no. 3, 2005, pp. 505-11.
Hern S, Stanton AW, Mellor RH, et al. In vivo quantification of the structural abnormalities in psoriatic microvessels before and after pulsed dye laser treatment. Br J Dermatol. 2005;152(3):505-11.
Hern, S., Stanton, A. W., Mellor, R. H., Harland, C. C., Levick, J. R., & Mortimer, P. S. (2005). In vivo quantification of the structural abnormalities in psoriatic microvessels before and after pulsed dye laser treatment. The British Journal of Dermatology, 152(3), 505-11.
Hern S, et al. In Vivo Quantification of the Structural Abnormalities in Psoriatic Microvessels Before and After Pulsed Dye Laser Treatment. Br J Dermatol. 2005;152(3):505-11. PubMed PMID: 15787819.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - In vivo quantification of the structural abnormalities in psoriatic microvessels before and after pulsed dye laser treatment. AU - Hern,S, AU - Stanton,A W B, AU - Mellor,R H, AU - Harland,C C, AU - Levick,J R, AU - Mortimer,P S, PY - 2005/3/25/pubmed PY - 2005/7/6/medline PY - 2005/3/25/entrez SP - 505 EP - 11 JF - The British journal of dermatology JO - Br J Dermatol VL - 152 IS - 3 N2 - BACKGROUND: Microvascular abnormalities (capillary elongation, widening and tortuosity) are a characteristic feature of psoriasis and form one of the pathological diagnostic criteria. These changes occur early in the progression of a psoriatic plaque, before there is clinical or histological evidence of epidermal hyperplasia. Treatment of psoriatic microvessels with a pulsed dye laser (PDL) has been associated with both clinical improvement and clearance of lesions. OBJECTIVES: To quantify the structural vascular abnormalities in plaque skin using noninvasive techniques in vivo. Investigations were carried out before and after PDL treatment to determine the nature of laser-induced microvascular changes and the relationship between these changes and clinical improvement. METHODS: Plaque microvessels were visualized using native capillaroscopy. Plaques were then treated three times with the PDL at 14-day intervals. Native capillaroscopy was repeated at 2 and 6 weeks after the final laser treatment. Images were analysed using a combination of nonstereological and stereological measurements. RESULTS: Whole body disease was stable. Treated plaques showed a 48% reduction in plaque severity score (P < 0.01). Native studies showed that the PDL significantly reduced plaque microvessel density (P < 0.05), image area fraction (P < 0.01), microvessel length density (P < 0.01) and vessel image width (P < 0.01). The reduction in plaque severity score (which denoted clinical improvement) was related quantitatively to the reduction in microvessel area per unit area of plaque skin, i.e. the image area fraction (correlation coefficient = 0.772, P < 0.01). The greatest response of plaque microvessels was within 2 weeks after the final laser treatment, while the greatest reduction in plaque severity score occurred between 2 and 6 weeks after the final laser treatment, i.e. clinical improvement was preceded by microvascular improvement. CONCLUSIONS: These findings indicate that there is a close correlation between the state of the superficial vasculature and the clinical status of psoriasis. The expanded superficial microvascular bed in plaque skin is a necessary component for maintaining clinical lesions and these blood vessels are thus a legitimate target for treatment. SN - 0007-0963 UR - https://www.unboundmedicine.com/medline/citation/15787819/In_vivo_quantification_of_the_structural_abnormalities_in_psoriatic_microvessels_before_and_after_pulsed_dye_laser_treatment_ DB - PRIME DP - Unbound Medicine ER -