Sector of Dermatology, Rio de Janeiro State University, Rio de Janeiro, Brazil.
Graduate Program in Pathology, School of Medicine, Fluminense Federal University, Rio de Janeiro, Brazil.
Int J Dermatol. 2018 Feb;57(2):209-216. doi: 10.1111/ijd.13883. Epub 2018 Jan 10.
Psoriasis is a chronic inflammatory disease. Pustular, erythrodermic, and extensive plaque psoriasis are responsible for systemic complications. Systemic capillary leak syndrome is the complication with greater progression to death and occurs due to vascular changes.
The aim of this study was to evaluate vascular changes through the expression of CD34 and ICAM-1 in plaque, pustular, and erythrodermic psoriasis.
The sample consisted of seven patients with erythrodermic psoriasis, 24 with moderate-severe plaque psoriasis, 14 with mild plaque psoriasis and 13 with pustular psoriasis. Patients were submitted to physical examination and skin biopsy for histopathological examination and immunohistochemical analysis with anti-CD34 and anti-ICAM-1 antibodies. Subsequently, tissue fragments were organized by groups using the Tissue Macroarray (TMA) technique to perform immunohistochemistry.
In 58 patients, analysis of vessels using anti-CD34 demonstrated vascular immunostaining in superficial dermis and between dermal papillae. There were more blood vessels in erythrodermic psoriasis, followed by plaque psoriasis. In erythrodermic psoriasis, there were small and few tortuous blood vessels with great dilatation, while plaque psoriasis presented larger vessels that were less dilated and more tortuous. There was an intense and localized expression of ICAM-1 in endothelial and lymphocytic cells in all groups, with significant differences.
Vascular alterations are important in psoriasis, with an increase in the number of blood vessels and ICAM-1 overexpression, especially in erythrodermic form. Therefore, vascular changes and the expression of intercellular adhesion molecules could help to diagnose the erythrodermic form of psoriasis.
银屑病是一种慢性炎症性疾病。脓疱型、红皮病型和广泛斑块型银屑病可导致全身并发症。全身性毛细血管渗漏综合征是一种进展性更大的死亡并发症，发生于血管变化。
本研究旨在通过斑块、脓疱型和红皮病型银屑病中 CD34 和 ICAM-1 的表达来评估血管变化。
该样本包括 7 例红皮病型银屑病患者、24 例中重度斑块型银屑病患者、14 例轻度斑块型银屑病患者和 13 例脓疱型银屑病患者。对患者进行体格检查和皮肤活检，进行组织病理学检查和抗 CD34 和抗 ICAM-1 抗体的免疫组织化学分析。随后，使用组织宏观阵列（TMA）技术将组织片段组织成组，进行免疫组织化学。
在 58 例患者中，使用抗 CD34 分析血管显示出浅真皮和真皮乳头之间的血管免疫染色。红皮病型银屑病的血管更多，其次是斑块型银屑病。在红皮病型银屑病中，小而扭曲的血管较多，扩张较大，而斑块型银屑病中血管较大，扩张较小，扭曲较多。所有组中内皮细胞和淋巴细胞中 ICAM-1 的表达均强烈且局限，差异有统计学意义。
血管改变在银屑病中很重要，尤其是在红皮病型银屑病中，血管数量增加和 ICAM-1 过表达。因此，血管变化和细胞间黏附分子的表达有助于诊断红皮病型银屑病。
