Videocapillaroscopic findings in the microcirculation of the psoriatic plaque during etanercept therapy

Authors


  • Conflict of interest: none declared.

Correspondence: Dr Giuseppe Stinco, Institute of Dermatology, University of Udine, Ospedale ‘San Michele’ di Gemona piazza Rodolone 1, 33013 Gemona del Friuli, Udine, Italy

E-mail: giuseppe.stinco@uniud.it

Summary

Background

Vascular endothelial growth factor (VEGF) is a pivotal cytokine in the pathogenesis of psoriasis, and upregulation of VEGF by tumour necrosis factor (TNF)-α and inflammatory factors causes marked alterations in the cutaneous microcirculation. Etanercept is a fully soluble TNF receptor fusion protein that primarily binds soluble TNF-α, thus blocking its pro-angiogenic function.

Aim

To assess the modifications in the superficial capillary bed in psoriatic plaques during treatment with etanercept.

Methods

The study enrolled 22 patients (13 men, 9 women; age range 31–74 years) with plaque psoriasis resistant to conventional therapy. The patients were stated on etanercept 50 mg/week, which was continued for 24 weeks. At the beginning of the study (baseline), and at weeks 6, 12, 18 and 24, in vivo videocapillaroscopy analysis of a selected plaque was performed. Levels of erythema, scaling and infiltration were assessed using a four-point plaque severity score, with an overall score obtained by the sum of these three scores. The Psoriasis Activity and Severity Index (PASI) was also determined.

Results

Etanercept produced a significant reduction in PASI, plaque severity score and diameter of the basket-weave area at every time point. Four patients had complete remission, although none of the patients regained a normal capillaroscopic pattern.

Conclusions

Similar to other conventional therapies, etanercept is able to improve PASI, plaque severity score and basket-weave area diameter, but it is unable to induce normalization of the microcirculation in psoriatic plaques.

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