title: Clearing of psoriasis documented by laser Doppler perfusion imaging contrasts remaining elevation of dermal expression levels of CD31.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Dermatology, Radboud University Medical Center, Enschede, The Netherlands.
authors.forename: A G M
authors.initials: AG
authors.lastname: Hendriks
authors.affiliation: Department of Dermatology, Radboud University Medical Center, Enschede, The Netherlands.
authors.forename: P C M
authors.initials: PC
authors.lastname: van de Kerkhof
authors.affiliation: Biomedical Photonic Imaging, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.
authors.forename: C S
authors.initials: CS
authors.lastname: de Jonge
authors.affiliation: Biomedical Photonic Imaging, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Lucas
authors.affiliation: Biomedical Photonic Imaging, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.
authors.forename: W
authors.initials: W
authors.lastname: Steenbergen
authors.affiliation: Department of Dermatology, Radboud University Medical Center, Enschede, The Netherlands.
authors.forename: M M B
authors.initials: MM
authors.lastname: Seyger
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D001623:Betamethasone / Q000008:administration & dosage; D015415:Biomarkers; D001783:Blood Flow Velocity; D002117:Calcitriol / Q000008:administration & dosage / Q000031:analogs & derivatives; D016207:Cytokines / Q000276:immunology; D003879:Dermatologic Agents / Q000008:administration & dosage; D004338:Drug Combinations; D005260:Female; D006801:Humans; D017078:Laser-Doppler Flowmetry / Q000379:methods*; D008297:Male; D008875:Middle Aged; D055655:NK Cell Lectin-Like Receptor Subfamily K / Q000276:immunology*; D009824:Ointments / Q000008:administration & dosage; D055420:Perfusion Imaging / Q000379:methods; D011565:Psoriasis / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012867:Skin / Q000187:drug effects / Q000503:physiopathology*; D015854:Up-Regulation / Q000276:immunology
chemical_list: D015415:Biomarkers; D016207:Cytokines; D003879:Dermatologic Agents; D004338:Drug Combinations; C527085:KLRK1 protein, human; D055655:NK Cell Lectin-Like Receptor Subfamily K; D009824:Ointments; C055085:calcipotriene; D001623:Betamethasone; D002117:Calcitriol
keywords: Laser Doppler perfusion imaging; TOPCam; betamethasone dipropionate ointment; calcipotriol; microcirculation; plaque heterogeneity; psoriasis