Abstract
BackgroundDilated and tortuous vessels within elongated dermal papillae represent a histopathological clue of psoriasis. However, the number of dilated capillaries (capillary density) in psoriasis remains undefined as the results from the available studies differ significantly.ObjectivesTo evaluate the capillary density in psoriasis using dermoscopy and horizontal histopathological sections (HHS), two techniques that share the horizontal view of the skin, and to compare the results with the existing data.MethodsTwenty adult patients with stable plaque psoriasis were enrolled and, in each patient, a target area of the examined plaque, previously engraved by gently rotating a 5-mm biopsy punch device, underwent dermoscopy and biopsy for HHS. In all examined fields, capillary density was evaluated in a centered 4-mm diameter area, counting the number of red dots at dermoscopy and of dermal papillae at HHS.ResultsA total of 20 target lesions located on the trunk, arms and tights were evaluated. The mean capillary density resulting from dermoscopy was 43.02±6.60/mm 2 whereas that from HHS was 50.30±9.05/mm 2. These data showed a statistically significant difference (p = 0.006), with a strong correlation at Pearson’s test (r = 0.88).ConclusionsOur results when compared with those from the existing literature showed some differences. The peculiarity of our work is represented by the precise measurement and correlation of the capillary density using two different methods, as the preliminary skin engraving allowed a perfect match between the area undergoing dermoscopy and that of skin sampling for HHS. Compared to dermoscopy in which deep-located vessels might have gone undetected, HHS seems to reflect more precisely and reliably the real capillary density showing an average of 50 capillaries/mm 2 that in a common 5x5 cm psoriatic patch corresponds to an average of 125.000 capillaries. These results highlight the extraordinary potential of psoriatic skin to develop such a complex and intricate vascular network.
Highlights
Psoriasis is a common skin disease whose complex pathogenetic mechanisms including vascular remodeling have recently been demonstrated
To evaluate the capillary density in psoriasis using dermoscopy and horizontal histopathological sections (HHS), two techniques that share the horizontal view of the skin, and to compare the results with the existing data
The mean capillary density resulting from dermoscopy was 43.02±6.60/mm 2 whereas that from HHS was 50.30±9.05/mm 2
Summary
Psoriasis is a common skin disease whose complex pathogenetic mechanisms including vascular remodeling have recently been demonstrated. Dilated and tortuous vessels within elongated dermal papillae represent a histopathological clue evident by dermoscopy, a non-invasive technique that magnifies (X10) the skin surface, as uniformly distributed “red dots” [1, 2]. A recent study using horizontal histopathological sections (HHS) on psoriatic skin confirmed the presence of roundish dermal papillae at the dermo-epidermal junction each centered by ectatic capillaries [3]. The objectives of this study were to evaluate the capillary density in psoriasis using HHS and to compare the results with those obtained using dermoscopy, sharing the horizontal view of the skin, and with the existing data. Dilated and tortuous vessels within elongated dermal papillae represent a histopathological clue of psoriasis. The number of dilated capillaries (capillary density) in psoriasis remains undefined as the results from the available studies differ significantly. Editor: Beatrice Nardone, Northwestern University Feinberg School of Medicine Galter Health Sciences Library, UNITED STATES
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