الفهرس 
PSORIASIOnly 14 pages are availabe for public view
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Abstract
Psoriasis is a systemic disease with inflammatory changes extending beyond the skin. Metabolic syndrome and adverse cardiovascular events are increased in psoriasis. Proper assessment and early identification of vascular abnormalities in those patients is of paramount importance to allow for early aggressive treatment.
Nail capillaroscopy is a non-invasive tool that can be used to detect vascular abnormalities at the level of nail fold capillaries. In psoriasis, endothelial dysfunction can be assessed in large arteries and small capillaries. In large arteries, dysfunction is seen in the form of increased CIMT. While in small capillaries it manifests as decreased capillary density with dilated elongated capillaries when examined by nail capillaroscopy.
The usage of nail capillaroscopy will allow for early detection of endothelial dysfunction manifested as tortuous vessels and edema. It can reflect the degree of vascular compromise allowing for proper identification of higher risk patients. Finally, it can be used for follow-up to detect reversal of capillaroscopy parameters to normal, ensuring the beneficial effect of treatment on endothelial function.
RECOMMENDATIONS
• Nail capillaroscopy should be used to assess endothelial function in psoriasis patients with high cardiovascular risk.
• Proper and early treatment is essential to reverse endothelial dysfunction occurring in psoriatic patients.
• Further studies should be done using dermoscopy, which will allow routine assessment of vascular function in the clinic for all psoriasis patients.
• Further studies should ensure statistically insignificant difference between the two groups regarding PASI score and psoriasis duration.
• Further studies assessing the effect of various treatment modalities on changes in nail capillaroscopy.
SUMMARY
Psoriasis is an immune-mediated inflammatory skin disease that is strongly associated with the clinical features of the metabolic syndrome (MetS), including abdominal obesity, hypertension, atherosclerosis, dyslipidemia, and diabetes. The strength of these associations has been repeatedly confirmed by several observational studies. In particular, the prevalence of MetS in patients with psoriasis ranges from 20% to 50%, with a risk of having MetS is at least double in psoriatic patients compared with non-psoriatic control individuals. MetS is also more common in patients with severe psoriasis than in those with mild skin disease.
Nail fold is one of the most accessible sites for studying changes in the microcirculation in various microangiopathies. The characterization of changes in microvasculature can provide useful clues towards the diagnosis and prognosis of a disease. Studies done so far on nail capillaroscopy in psoriasis are scarce and show conflicting results.
The aim of our work was to detect nail capillaroscopy changes in psoriasis, in patients with and without metabolic syndrome. Nail capillaroscopy may allow early detection of vascular changes, even before they are manifested clinically. This will allow for early identification of psoriatic patients with increased cardiovascular risk, which gives a chance for early proper management of those patients. We enrolled 65 patients with moderate-severe psoriasis and were divided into two groups according to the presence or absence of metabolic syndrome.
Our study showed that in patients with more severe psoriasis, especially with increased duration, there is higher risk of endothelial dysfunction which can be assessed in large arteries and small capillaries. In large arteries, dysfunction is seen in the form of increased CIMT. While in small capillaries it manifests as decreased capillary density with dilated elongated capillaries when examined by nail capillaroscopy. Moreover, capillary tortuosity and edema can be considered as early markers of endothelial dysfunction, while capillary branching and hemorrhage are indicative of a late-stage disease. Furthermore, follow-up revealed reversal of some of the capillary abnormalities in relation to improvement of psoriasis severity.
In conclusion, nail capillaroscopy can be a very important tool in detecting early endothelial dysfunction in psoriatic patients manifested by edema and tortuous capillaries. Moreover, it can reflect the degree of vascular compromise allowing proper identification of patients at high risk for cardiovascular events, which warrants aggressive early treatment. In addition, it can be used for follow-up to detect reversal of vascular structures back to normal indicating treatment success at the level of systemic vasculature. We recommend the use of nail capillaroscopy as an important tool in screening and assessing psoriatic patients for cardiovascular compromise.