Microvascular Reactivity and Systemic Vascular Resistance Reflect Inflammatory Burden in Psoriasis

Background/Objectives: Psoriasis is a systemic immune-mediated inflammatory disease
associated with endothelial dysfunction and cardiovascular risk. This study evaluated
relationships among clinical severity, cytokine activity, systemic vascular resistance, and
skin microvascular reactivity in chronic plaque psoriasis before and after therapy. Methods: In this prospective longitudinal study, 34 patients with chronic plaque psoriasis and
19 matched controls were assessed. Patients were examined at baseline and after 12 months
of clinically indicated systemic therapy. Psoriasis Area and Severity Index (PASI), serum
IL-17A, IL-22, TNF-α, IL-12(p40), IL-10, VEGF-A, total peripheral resistance, and laser
Doppler flowmetry post-occlusive reactive hyperemia indices were analysed. Results:
PASI decreased markedly after therapy, from 20.6 ± 7.7 to 4.1 ± 5.3, with excellent discrimination between pre- and post-treatment states. IL-17A, IL-22, and IL-12(p40) decreased
significantly, while TNF-α remained associated with disease severity. Total peripheral
resistance and delayed psoriatic-skin hyperemia persisted and correlated with inflammatory/angiogenic markers, particularly IL-12(p40) and VEGF-A. Conclusions: Long-term
therapy improves clinical and cytokine profiles in psoriasis, but vascular dysfunction may
persist despite cutaneous improvement. Integrated cytokine–vascular assessment may
complement PASI for evaluating systemic inflammatory burden and cardiovascular risk.