| Background Psoriasis(PSO)is a common,immune-mediated chronic inflammatory disease in dermatology.The typical skin lesions are mainly characterized by scaly erythema or plaques,which are localized or widely distributed and may involve the skin,fingernail(toenail),joint,etc.According to its clinical characteristics,it can be divided into vulgaris,arthropathy,pustule and erythroderma,among which psoriasis vulgaris is the most common and plaque psoriasis is one of them.Currently,the main treatment option for moderate-to-severe plaque psoriasis is biologic therapy,the most commonly used clinically being subcutaneous injections of secukinumab and drug tapering and discontinuation is largely dependent on clinical skin lesion scores,which has limitations.It can be used to describe and quantify the dynamic changes of skin microstructure by using reflectance confocal microscopy(RCM).The characteristics of RCM in psoriasis are strongly correlated with histopathology.Objective The microscopic changes of patients with moderate to severe plaque psoriasis before and after the treatment with seckinumab were studied by reflection confocal microscop y,focusing on measuring RCM parameters of dermal papillae and capillary loops and compari ng whether there were differences in microscopic changes in lesions at different sites to invest igate the correlation between RCM parameters and clinical outcomes.Methods The study was a prospective study with an auto-controlled trial.A total of 11patients with moderate-severe plaque psoriasis who met the inclusion and rejection criteria were enrolled.11 patients received subcutaneous injections of 300mg of seckinumab(secukinumab,marketed as Cosentyx)at baseline and at weeks 1,2,3,and 4,followed by an injection of300mg every 4 weeks.RCM examination was performed on 53 target lesions at different sites,and the clinical efficacy was evaluated by local psoriasis severity index(LPSI)score.Results(1)The area,circumference and diameter of dermal papillae(DP)before treatment of53 target lesions were 6691.04±2119.9μm~2、303.9±54.12μm、109.95±19.5μm,the area,circumference and diameter values of the skin lesions DP after 12 weeks of treatment were4489.67±1363.98μm~2、245.12±37.17μm、87.01±14.66μm.The area,circumference and diameter of the capillary loops(CL)of the lesions before treatment were 232.8±101.41μm~2、55.44±12.16μm、19.64±4.44μm,while after 12 weeks of treatment the area,circumference and diameter of the CL of the lesions were 120.07±49.51μm~2,(39.15±8.01)μm and(13.77±2.98)μm respectively,all indexes decreased significantly after treatment(P<0.001).(2)After 12 weeks of treatment,the 53 lesions were 16 in the upper extremity group,19 in the trunk group and 18 in the lower extremity group.when comparing the three groups,the rate of change in DP diameter was lower in the lower extremity group than in the upper extremity and trunk groups(P<0.05),and there was no significant difference between the upper extremity and trunk groups(P>0.05),while the rate of change in CL diameter was not statistically different between the three groups.(3)After 12 weeks of treatment,the incidence of hyperkeratosis and epidermal inflammatory cell infiltration(Munro microabscess)in lesions was significantly reduced(P<0.001),the incidence of dermal papillae with marginal pigment rings was significantly increased(P<0.001)and the incidence of active cells in capillaries was significantly reduced.(4)According to Spearman’s correlation analysis,the rate of change in LPSI before and after treatment correlated well with the rate of change in DP diameter(r_s=0.6448,P<0.0001)and with the rate of change in CL diameter(r_s=0.3392,P=0.0031).(5)Of the 11 patients,only 2 patients were treated with secukizumab until 20 weeks and the rest were lost to follow-up.The area,circumference and diameter of the dermal papillae of the 8marked lesions were 3479.83±861.7μm~2、214.94±25.06μm、74.38±13.16μm respectively,and only 3 lesions had clearly identifiable and measurable capillary loops,which area,circumference and diameter were122.5±20.68μm~2、39.13±3.69μm、14.69±1.23μm respectively.Conclusion After 12 weeks of treatment with secukinumab,the area,circumference and diameter of dermal papillae and capillary loops decreased in plaque psoriasis lesions,and the rate of change in dermal papillae diameter was significantly smaller in lower limb lesions than in upper limb and trunk lesions.The rate of change in LPSI before and after treatment was strongly correlated with the rate of change in dermal papilla diameter,but less so with the rate of change in capillary loops diameter.The change rate of LPSI before and after treatment was strongly correlated with the change rate of dermal papilla diameter,but weakly correlated with the change rate of capillary loops diameter.Clinical cure of psoriatic lesions is not the best time to discontinue biologics.RCM parameters of skin lesions can be used as microscopic indicators to dynamically monitor the efficacy of biologics and may provide a more objective basis for dose reduction and discontinuation of drugs. |
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