title: Dermoscopic hemorrhagic dots: an early predictor of response of psoriasis to biologic agents.
abstract: BACKGROUND
  Biologic agents are routinely used in the treatment of severe psoriasis. The evaluation of treatment response is mainly based on the physician's global clinical assessment.
  
  
  OBJECTIVE
  To investigate whether dermoscopy might enhance the assessment of response of psoriasis to treatment with biologic agents.
  
  
  METHODS
  Patients with severe psoriasis scheduled to receive a biologic agent were enrolled in the study. A target lesion from each patient was clinically and dermoscopically documented at baseline and after one, two and six months. The clinical response was evaluated by the recruiting clinicians at all visits, while dermoscopic images were evaluated by two independent investigators, blinded to the clinical information. Chi Square test was used for cross-tabulation comparisons, while odds ratios, 95% confidence intervals and p values were calculated using univariate logistic regression.
  
  
  RESULTS
  Overall, there was a significant correlation between clinical response and vessel distribution at all time points: a regular vessel distribution correlated with no response, a clustered distribution with partial response, and the dermoscopic absence of vessels with complete response. The presence of dermoscopic hemorrhagic dots was a potent predictor of favorable clinical response at the subsequent visit at all time points. Among lesions initially clinically responding and later recurring, 87.5% displayed dermoscopic dotted vessels despite the macroscopic remission.
  
  
  CONCLUSIONS
  Dermoscopy might be a useful additional tool for evaluating the response of psoriatic patients to biologic agents. Hemorrhagic dots represent an early predictor of clinical response, while the persistence or reappearance of dotted vessels might predict clinical persistence or recurrence, respectively.
authors.affiliation: First Department of Dermatology, Aristotle University, Thessaloniki, Greece.
authors.forename: Aimilios
authors.initials: A
authors.lastname: Lallas
authors.affiliation: Department of Dermatology, Second University, Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Argenziano
authors.affiliation: Non-melanoma Skin Cancer Unit, Department of Dermatology, Medical University, Graz, Austria.
authors.forename: Iris
authors.initials: I
authors.lastname: Zalaudek
authors.affiliation: First Department of Dermatology, Aristotle University, Thessaloniki, Greece.
authors.forename: Zoe
authors.initials: Z
authors.lastname: Apalla
authors.affiliation: Clinical Dermatology Department, IFO-San Gallicano Dermatological Institute, Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Ardigo
authors.affiliation: Instituto de Dermatologia Professor Rubem David Azulay-Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Patricia
authors.initials: P
authors.lastname: Chellini
authors.affiliation: Instituto de Dermatologia Professor Rubem David Azulay-Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Natalia
authors.initials: N
authors.lastname: Cordeiro
authors.affiliation: Instituto de Dermatologia Professor Rubem David Azulay-Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Mariana
authors.initials: M
authors.lastname: Guimaraes
authors.affiliation: Skin Cancer Unit, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
authors.forename: Athanassios
authors.initials: A
authors.lastname: Kyrgidis
authors.affiliation: First Department of Dermatology, Aristotle University, Thessaloniki, Greece.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lazaridou
authors.affiliation: Skin Cancer Unit, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Longo
authors.affiliation: Skin Cancer Unit, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
authors.forename: Elvira
authors.initials: E
authors.lastname: Moscarella
authors.affiliation: First Department of Dermatology, Aristotle University, Thessaloniki, Greece.
authors.forename: Ilias
authors.initials: I
authors.lastname: Papadimitriou
authors.affiliation: Department of Dermatology, University of Modena, Modena, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pellacani
authors.affiliation: First Department of Dermatology, Aristotle University, Thessaloniki, Greece.
authors.forename: Elena
authors.initials: E
authors.lastname: Sotiriou
authors.affiliation: First Department of Dermatology, Aristotle University, Thessaloniki, Greece.
authors.forename: Efstratios
authors.initials: E
authors.lastname: Vakirlis
authors.affiliation: First Department of Dermatology, Aristotle University, Thessaloniki, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Ioannides
keywords: dermoscopy; psoriasis