Dr. André Laureano

Dermatologist

Psoriasis, Confocal Microscopy and Biological Therapy
A trio that belongs together

HPA Magazine 7

Psoriasis is a systemic, chronic, immune-mediated (related to the immune system and with environmental and genetic interactions) disorder that as yet has no cure. It can appear in various forms: in plaques, pustular or erythrodermic, and can appear discretely or, quite the opposite, manifest itself in a severe and extensive way, including the skin, nails and joints.

In regard to its physiopathology, psoriasis results from activity of the T lymphocytes (cells responsible for the defences of the organism), which begin to attack the skin cells. Starting from there, the immunological response begins, which includes dilation of the blood vessels of the skin and production of other white globules. However, as the skin cells are being attacked, an increase in their production can be seen, but in such a way as they do not complete the normal evolution cycle. As a result of this exaggerated and non-interrupted cellular and molecular activity, the typical clinical findings of flaking and erythema that characterise the psoriasis plaques and its chronic character can be observed.
Psoriasis often jeopardises the quality of life of the sufferers, sometimes affecting their social, family, professional and sexual relationships. Nevertheless, it can not be stressed enough that this is not a contagious disease and therefore there is no need to avoid contact.
Confocal reflectance microscopy has taken on an increasing importance in Dermatology, as an innovative technique in the diagnosis not only for tumoral pathology, but also for inflammatory disorders, where psoriasis is the prime example, not only for its physiopathology but also for its high prevalence in the general population and constant advances in innovative biological therapeutics. Confocal microscopy stands out for being a fast, non-invasive, in vivo diagnostic, substituting aggressive skin biopsies in cases where the clinical diagnosis can be difficult. On the other hand, it is the ideal technique for assessing the efficiency (or not) of the ongoing therapeutics.
Confocal microscopy uses a diode Laser as a source of light and allows for the detailed display of cellular structures of the skin, with a resolution similar to that of a histological exam, but with the advantage of not causing tissue damage. 
The reflexion of Laser radiology allows for high resolution observation of the skin in the area of the lesion “in question”, the result of which is a “more perfect”, “clearer” image and interpretation of these structures, thus permitting increased precision of the correct diagnosis for the dermatologist, explains Dr. André Laureano.
Besides this, as this technique is done “in vivo” and in real time, the first diagnosis can be given immediately after the interpretation of the images captured. 
According to Dr. Laureano, of all the new non-invasive diagnostics methods, confocal microscopy is the only technique with a resolution close to a histopathology exam, identifying structures of the epidermis as well as the superficial dermis, with the advantage of not being aggressive or invasive. 
Biological therapy is based on new knowledge of biotechnology, with the identification of specific targets responsible for the activity of diseases, blocking them in a selective way and halting the structural damage they often provoke. These drugs have revolutionised the treatment of many autoimmune diseases, offering an enormous impact on the quality of life of those affected.
Contrary to the drugs produced by chemical synthesis, biological medications have a different action mechanism, as they are capable of restricting the area of activity and acting in a specific, case-by-case way, a characteristic that allows the treatment to be personalised and furthering its greater efficiency. therapeutic biology can be derived from hormones (insulin, erythropoietin); monoclonal antibodies (antibodies similar to those produced in the body and adapted to react specifically on selected targets); hemoderivatives; immunology medications (such as serums and vaccines); allergens; technologically advanced products (such as genes and cellular therapy products), cytokines (inteferons and interleukins); haematopoietic growth factors; recombined growth factors and blood coagulation factors.
The experience of the HPA in the treatment of psoriasis through biological therapy could not be more positive, says Dr. André Laureano.
As an example of the efficiency of this group of drugs, we have demonstrated the case of a male patient with common psoriasis with severe plaques, treated in our Unit with secucinumab, with a positive clinical result. Images before and after 8 weeks of treatment.
The Hospital Particular do Algarve is certified by the Prescription Centre for Biological Agents, accredited by the General Directorate of Health (DGS) for psoriasis in plaques and psoriatic arthritis, as well as for rheumatoid arthritis, ankylosing spondylitis, polyarticular juvenile arthritis and non-paediatric inflammatory intestinal diseases.