The Role of Dermoscopy and High-Frequency Ultrasonography in the Diagnosis and Monitoring of Psoriasis Vulgaris.

Psoriasis vulgaris is a polygenic, immunomediated dermatological condition, characterized pathophysiologically by abnormal proliferation of the epidermis and immune response disorders, evidenced by the presence of a dermal inflammatory infiltrate accompanied by exocytosis. The prevalence of this disease is continuously increasing, and the significant impact on quality of life is determined by both the severity of the skin manifestations and the associated comorbidities, which underlines the importance of early diagnosis. Among the imaging methods useful in the diagnosis and monitoring of psoriasis vulgaris are dermatoscopy and high-frequency cutaneous ultrasonography (HFUS). Dermatoscopy is a valuable complementary imaging tool in assessing the therapeutic response in patients with psoriasis vulgaris. Although clinical lesions may show partial or complete remission, the persistence of the specific vascular architecture-characterized by dilated and branched capillaries-suggests the maintenance of disease activity and justifies the need for continued treatment. HFUS allows the identification of characteristic changes in psoriatic plaques, such as homogeneous thickening of the epidermis, visible as a hyperechoic band, the presence of a hypoechoic subepidermal band, and thickening of the dermis. Evaluation with 20 MHz probes can significantly contribute to monitoring therapeutic efficacy, since the first observable changes under topical and/or systemic treatment include a reduction in the thickness of the epidermis, dermis, and hypoechoic subepidermal band. The integration of dermatoscopy and HFUS within the clinical evaluation allows for a complex and precise approach to the management of patients with psoriasis vulgaris, facilitating objective monitoring of disease progression and appropriate adjustment of therapy.