中度至重度斑块状银屑病患者生物治疗反应的临床、皮肤镜及超声监测
Clinical, dermoscopic, and ultrasonic monitoring of the response to biologic treatment in patients with moderate-to-severe plaque psoriasis.
作者信息
Wang Juncheng, Zhu Qingli, Li Feng, Xiao Mengsu, Liu Jie
机构信息
Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China.
Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
出版信息
Front Med (Lausanne). 2023 Jun 26;10:1162873. doi: 10.3389/fmed.2023.1162873. eCollection 2023.
BACKGROUND
Assessment of therapeutic response of psoriasis has relied traditionally on clinical observation, and effective non-invasive tools are desirable.
OBJECTIVES
To investigate the value of dermoscopy and high-frequency ultrasound (HFUS) in the monitoring of psoriatic lesions treated with biologics.
METHODS
Patients with moderate-to-severe plaque psoriasis treated with biologics were evaluated by clinical, dermoscopic, and ultrasonic scores at weeks 0, 4, 8, and 12. Clinical scores, including Psoriasis Area Severity Index (PASI) and target lesion score (TLS), were evaluated at representative lesions. Dermoscopy was performed to assess the red background, vessels, and scales on a 4-point scale as well as the presence of hyperpigmentation, hemorrhagic spots, and linear vessels. HFUS was performed to measure the thicknesses of the superficial hyperechoic band and subepidermal hypoechoic band (SLEB). The correlation between clinical, dermoscopic, and ultrasonic evaluation was also analyzed.
RESULTS
In total, 24 patients were analyzed and achieved 85.3 and 87.5% reduction of PASI and TLS, respectively, after 12 weeks of treatment. The red background, vessels, and scales scores under dermoscopy were reduced by 78.5, 84.1, and 86.5%, respectively. Some patients developed hyperpigmentation and linear vessels after treatment. Hemorrhagic dots slowly subside over the therapeutic course. Ultrasonic scores were significantly improved with an average reduction of 53.9% in superficial hyperechoic band thickness and 89.9% in SLEB thickness. TLS in the clinical variables, scales in dermoscopic variables, and SLEB in ultrasonic variables decreased the most significantly in the early stage of treatment (week 4) with 55.4, 57.7, and 59.1% ( > 0.05), respectively. Most of the variables, including the red background, vessels, scales, and SLEB thickness, were strongly correlated with TLS. High correlations were also found between the SLEB thickness and the red background or vessels scores, and between the superficial hyperechoic band thickness and the scales scores.
CONCLUSION
Both dermoscopy and HFUS were useful in the therapeutic monitoring of moderate-to-severe plaque psoriasis.
背景
银屑病治疗反应的评估传统上依赖于临床观察，因此需要有效的非侵入性工具。
目的
探讨皮肤镜检查和高频超声（HFUS）在监测接受生物制剂治疗的银屑病皮损中的价值。
方法
对接受生物制剂治疗的中度至重度斑块状银屑病患者在第0、4、8和12周进行临床、皮肤镜和超声评分评估。在代表性皮损处评估临床评分，包括银屑病面积和严重程度指数（PASI）和靶皮损评分（TLS）。进行皮肤镜检查，以4分制评估红色背景、血管和鳞屑，以及色素沉着、出血点和线性血管的存在情况。进行HFUS检查以测量浅表高回声带和表皮下低回声带（SLEB）的厚度。还分析了临床、皮肤镜和超声评估之间的相关性。
结果
共分析了24例患者，治疗12周后，PASI和TLS分别降低了85.3%和87.5%。皮肤镜检查下红色背景、血管和鳞屑评分分别降低了78.5%、84.1%和86.5%。部分患者治疗后出现色素沉着和线性血管。出血点在治疗过程中逐渐消退。超声评分显著改善，浅表高回声带厚度平均降低53.9%，SLEB厚度平均降低89.9%。临床变量中的TLS、皮肤镜变量中的鳞屑和超声变量中的SLEB在治疗早期（第4周）下降最为显著，分别为55.4%、57.7%和59.1%（>0.05）。大多数变量，包括红色背景、血管、鳞屑和SLEB厚度，与TLS密切相关。SLEB厚度与红色背景或血管评分之间，以及浅表高回声带厚度与鳞屑评分之间也存在高度相关性。
结论
皮肤镜检查和HFUS在中度至重度斑块状银屑病的治疗监测中均有用。
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