The Use of High-Frequency Skin Ultrasound in the Evaluation of Psoriatic Plaques-A Pilot Comparative Study Between Conventional and Biological Therapy.

Introduction. Psoriasis is a chronic inflammatory disease histologically characterized by epidermal hyperproliferation, altered keratinocyte differentiation and dermal vascular remodeling. Although the diagnosis is mainly clinical, non-invasive imaging methods, such as high-frequency skin ultrasound, allow an objective assessment of skin changes and disease activity. Material and Methods. We conducted a pilot, observational, cross-sectional and comparative study, conducted within the Dermatovenerology Department of the Central Military Emergency Hospital "Dr. Carol Davila", Bucharest, which included 40 patients diagnosed with psoriasis vulgaris, of whom 22 received conventional systemic treatment (methotrexate 15 mg/week), and 18 received biological therapy. For each patient, a representative, clinically active and recently appeared psoriatic plaque was evaluated with ultrasound, and the thickness of the epidermis, the thickness of the dermis, the thickness of the hypoechoic subepidermal band (SLEB) and the Doppler signal were analyzed. Statistical analysis was performed using SPSS v26. Results. Patients under biologic therapy had significantly lower ultrasound parameters compared to those under conventional systemic therapy, especially regarding epidermis thickness, hypoechoic subepidermal band thickness and Doppler signal. The PASI score was significantly higher in the conventionally treated group. Also, significant positive correlations were found between the PASI score and the hypoechoic subepidermal band thickness and the Doppler signal, Conclusions. Ultrasound parameters represent useful objective markers in the evaluation of psoriasis, reflecting disease activity. Patients under biologic therapy presented, at the time of evaluation, imaging parameters suggestive of reduced skin inflammation compared to those treated conventionally.