Hendriks A G M, van de Kerkhof P C M, de Jonge C S, Lucas M, Steenbergen W, Seyger M M B
Department of Dermatology, Radboud University Medical Center, Enschede, The Netherlands.
Biomedical Photonic Imaging, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.
Skin Res Technol. 2015 Aug;21(3):340-5. doi: 10.1111/srt.12198. Epub 2014 Dec 23.
Vascular modifications represent a key feature in psoriatic plaques. Previous research with Laser Doppler Perfusion Imaging (LDPI) revealed a remarkable heterogeneity in the cutaneous perfusion within homogenous-appearing psoriatic lesions. Insights in the relation between perfusion during treatment and related biological changes are lacking.
To study the effect of calcipotriol-betamethasone dipropionate ointment on the microcirculation and the expression levels of immunohistochemical markers in psoriatic lesions compared to the distant uninvolved skin.
Psoriatic lesions of fourteen patients were treated once a day during 8 weeks. Clinical SUM scores and the perfusion intensity by means of LDPI were assessed every 2 weeks. After 8 weeks, a biopsy from the target lesion and one from the distant uninvolved skin were taken and stained for psoriasis-related markers, like IL-17 and CD31.
After 8 weeks, seven patients reached a SUM score of 0 or 1, and were classified as good-responders. The other patients were classified moderate-responders. The perfusion intensity decreased in all lesions during therapy. In the good-responders, all investigated psoriasis-related proteins within the treated lesions reached the expression level found within the distant uninvolved skin. The expression of CD31, however, was significantly higher in the treated lesions as compared to the distant uninvolved skin (p = 0.0156). In the moderate responders, almost all expression levels remained significantly elevated compared to the uninvolved skin.
In the skin of good-responders the expression of dermal CD31(+) endothelium remains significantly elevated within the treated lesions compared with the distant uninvolved skin, whereas a marked reduction in the perfusion intensity and SUM score was found. This indicates that clinical improvement might outrun endothelial changes.
血管改变是银屑病斑块的一个关键特征。先前使用激光多普勒灌注成像（LDPI）的研究显示，在外观均匀的银屑病皮损内，皮肤灌注存在显著的异质性。目前尚缺乏关于治疗期间灌注与相关生物学变化之间关系的见解。
与远处未受累皮肤相比，研究卡泊三醇倍他米松二丙酸酯软膏对银屑病皮损微循环及免疫组化标志物表达水平的影响。
14例患者的银屑病皮损连续8周每天治疗1次。每2周评估临床SUM评分及通过LDPI测得的灌注强度。8周后，从目标皮损及远处未受累皮肤各取一块组织活检，进行银屑病相关标志物如IL-17和CD31的染色。
8周后，7例患者SUM评分为0或1，被归类为良好反应者。其他患者被归类为中度反应者。治疗期间所有皮损的灌注强度均下降。在良好反应者中，治疗皮损内所有研究的银屑病相关蛋白均达到远处未受累皮肤的表达水平。然而，与远处未受累皮肤相比，治疗皮损中CD31的表达显著更高（p = 0.0156）。在中度反应者中，与未受累皮肤相比，几乎所有表达水平仍显著升高。
在良好反应者的皮肤中，与远处未受累皮肤相比，治疗皮损内真皮CD31(+)内皮细胞的表达仍显著升高，而灌注强度和SUM评分则显著降低。这表明临床改善可能先于内皮细胞变化。
