Skin Capacitance Mapping of Early Effects of Methotrexate and Etanercept Biotherapy on Plaque Type Psoriasis

Research Article

Austin J Dermatolog. 2015; 2(2): 1038.

Skin Capacitance Mapping of Early Effects of Methotrexate and Etanercept Biotherapy on Plaque Type Psoriasis

Gérald E Piérard1*, Sébastien L Piérard2 and Claudine Piérard- Franchimont3,4

1Laboratory of Skin Bioengineering and Imaging (LABIC), Department of Clinical Sciences, University of Liege, Belgium

2Telecommunications and Imaging, Laboratory INTELSIG, Montefiore Institute, Liege University, Belgium

3Department of Dermatopathology, Unilab Lg, University Hospital of Liege, Belgium

4Department of Dermatology, Regional Hospital of Huy, Belgium

*Corresponding author: Gérald E Piérard, Department of Clinical Sciences, University of Liege, Belgium

Received: July 30, 2015; Accepted: November 10, 2015; Published: November 12, 2015


In its moderate-to-severe forms, psoriasis of the skin is an immune-mediated disorder that is commonly treated by biologicals. There is a need to design some objective noninvasive analytical methods for assessing the early signs of efficacy of such drugs. In recent years, in vivo real-time Skin Capacitance Mapping (SCM) has been offered for such evaluations. We presently assess SCM in two groups of 11 adult psoriatic patients treated with either Methotrexate (MTX) or Etanercept (ETC) monotherapies. Cyanoacrylate Skin Surface Strippings (CSSS) were collected at inclusion and after a 6-week period of treatment. The acute progression of psoriasis was identified by darker areas at SCM corresponding to subtle serosity deposits in the stratum corneum. CSSS and SCM seem to represent two noninvasive objective methods assessing the initial phase of psoriasis improvement following systemic therapies.

Keywords: Psoriasis; Skin capacitance mapping; Biologicals; Methotrexate; Etanercept; Cyanoacrylate skin surface stripping


Psoriasis is a chronic disabling Immune-Mediated Inflammatory Disorder (IMID) of the skin commonly associated with an increased incidence of some comorbidity including arthropathies, cardiovascular disease, metabolic syndrome, obesity, and type 2 diabetes [1-3]. In moderate-to-severe skin psoriatic lesion grades, a mindful holistic approach to the patient, commonly relies on selective systemic anti-inflammatory treatments [1,4,5]. Some recent progress in skin immunopathology has upgraded the perception of psoriasis pathogenesis [6,7]. It fostered new treatment options based on rational advances for psoriatic patients [2]. When drugs are administered as monotherapies or combined treatments, proinflammatory cytokines, including Tumor Necrosis Factor (TNF) and specific interleukins (IL12 and 23) are possibly targeted. They globally exert a favourable balance between efficacy and safety [8,9].

The Psoriasis Area and Severity Index (PASI) score is commonly used at the drug selection at inclusion [10-14]. A severe PASI score is commonly a benchmark for selecting a monotherapeutic option including Methotrexate (MTX) and Etanercept (ETC) administrations. Unfortunately, there is a poor objective and uniform clinical selection among psoriasis patients in controlled trials, there are some safety concerns, and the assessment of the treatment efficacy remains limited on clinical ground [15].

Only a few noninvasive clinical methods are currently designed for assessing the initial treatment efficacy of plaque type psoriasis on an individual basis. One way compares the treatment duration leading to the reduction in PASI score by 75% (PASI 75). Similar comparisons are performed using PASI 50 and PASI 90 reductions. A distinct comparative procedure relies of in vivo real-time Skin Capacitance Mapping (SCM) that represents an innovative method in the field [3,16,17]. SCM records some electrometric properties of the skin that are influenced by the combination of Stratum Corneum (SC) texture and micro relief, its water content, its electrolyte components, and the sweat production [3,16-18]. The SCM method is rooted on water permittivity, which is higher than for most bio-molecular compounds. Still another procedure involves Cyanoacrylate Skin Surface Strippings (CSSS) that are conveniently collected from the margins of the psoriatic plaques (Figure 1). The method was previously described in details [19-21]. Psoriasis is fostered by peculiar activation of TH1 lymphocytes [6,7] and CD123+ plasmacytoid dendritic cells [22]. These cells release various pro-inflammatory cytokines [23]. The resulting complex process probably correlates positively with the severity of clinical presentations.