Hypodermal adipose tissue sonoelastography for monitoring treatment response in patients with plaque psoriasis

Background: Psoriasis (PsO) is a multifactorial chronic and relapsing skin disease that affects about 125 million people in the world. Several studies have demonstrated the link between adipose tissue, inflammation, and PsO. The purpose of our study is to evaluate hypodermal adipose tissue inflammation underneath PsO plaques quantifying tissue elasticity with sonoelastography before and after treatment. The study was conducted at the Department of Dermatology of the University of "Rome Tor Vergata" and Department of Radiology of the University of "Rome Tor Vergata." Methods: We enrolled 60 patients with plaque PsO and a PASI score of ≥5 divided in three groups of treatment: biologic drugs therapy (Group A), systemic therapy with DMARDS (Group B), and topic therapy (Group C). Each Patient underwent sonoelastography examination (TE: transient elastography) at baseline (T0) and after 1 month (T1) of treatment. The region of interest (ROI) 5 × 5 mm area and the strain ratio was obtained dividing muscular elasticity (referral tissue) by hypodermal elasticity. Results: The difference between T0 and T1 was referred as Δ strain. Sonoelastography is able to identify hypodermal adipose tissue involvement in plaque PsO and on the basis of our experience it could represent a valid method to assess early therapy response in patient with plaque PsO. Conclusions: This is the first report regarding the use of sonoelastography in psoriatic patients. Sonoelastography is easy to use, rapid, and is a portable technique that does not use ionizing radiation. The result showed the mean lesional strain ratio significantly higher than the nonlesional one at baseline examination. In the future, the role of ultrasound sonoelastography is likely to be complementary to conventional imaging techniques in providing an additional tool