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

Background. Vascular endothelial growth factor (VEGF) is a pivotal cytokine in the pathogenesis of psoriasis, and upregulation of VEGF by tumour necrosis factor (TNF)- and inflammatory factors causes marked alterations in the cutaneous microcirculation. Etanercept is a fully soluble TNF receptor fusion protein that primarily binds soluble TNF-, 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 31-74years) with plaque psoriasis resistant to conventional therapy. The patients were stated on etanercept 50mg/week, which was continued for 24weeks. 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.