Beyond Clinical Scoring: Can High-Frequency Ultrasound and Power Doppler Detect Subclinical Activity in Psoriasis

Maha Mohammed Mahmoud; Suroor Rafea Alkumait

doi:10.31149/ijimm.v4i8.2979

Authors

Maha Mohammed Mahmoud Department of Diagnostic Radiology, College of Medicine, Tikrit University, Tikrit, Salah al-Din Governorate, Iraq
Suroor Rafea Alkumait Department of Dermatology, College of Medicine, Tikrit University, Tikrit, Salah al-Din Governorate, Iraq

DOI:

https://doi.org/10.31149/ijimm.v4i8.2979

Keywords:

Psoriasis, High-frequency ultrasound, Power Doppler, Subepidermal low-echogenic band, SLEB, PASI, Subclinical inflammation, Skin ultrasonography

Abstract

Psoriasis is a chronic inflammatory skin disease and that clinical severity scores may not be a good indicator of the inflammatory activity. High-frequency ultrasound (HFUS) and Power Doppler (PD) offer non-invasive imaging of structural and vascular variations of psoriatic plaques. The purpose of this study was to assess whether HFUS and PD can detect subclinical inflammatory activity that is not detected by conventional clinical assessment. The prospective observational cross-sectional study took place from March 2025-May 2026 in private dermatology and radiology/ultrasound clinics. The patients were 50 adults’ patients with psoriasis vulgaris from 18-60 years old, both male and female were enrolled. All participants were assessed dermatologically according to the Psoriasis Area and Severity Index (PASI) and then by HFUS and PD of a representative psoriatic plaque and adjacent clinically normal skin. The epidermal thickness, dermal thickness, subepidermal low-echogenic band (SLEB) thickness, total skin thickness, and Power Doppler vascularity were measured. Psoriatic plaques demonstrated significantly greater epidermal thickness (0.38 ± 0.09 vs. 0.21 ± 0.05 mm), dermal thickness (1.72 ± 0.31 vs. 1.24 ± 0.22 mm), SLEB thickness (0.42 ± 0.15 vs. 0.09 ± 0.05 mm), and total skin thickness (2.10 ± 0.34 vs. 1.45 ± 0.24 mm) compared with clinically normal skin (all P < 0.001). Vascularity was detected in 86.0% of plaques and moderate to marked vascularity was found in 62.0%. The 72.2% of patients who had mild psoriasis (PASI <5) had at least one significant ultrasound abnormality. PASI was significantly correlated with SLEB thickness (r 0.68; P < 0.001) and Power Doppler vascularity (r 0.72; P < 0.001). The ROC analysis showed that all three parameters (Power Doppler vascularity, SLEB thickness, or their combination) performed well, with the combination of Power Doppler vascularity and SLEB thickness showing an AUC of 0.96. HFUS and Power Doppler are able to demonstrate structural and vascular inflammatory abnormalities which may be underdiagnosed with traditional clinical score, especially in patients with mild psoriasis. SLEB and Power Doppler vascularity exhibited excellent diagnostic performance, and may be useful as a non-invasive tool in the detection of sub clinical activity. The combination of ultrasound biomarkers with clinical evaluation may help to better characterize the disease objectively and help to monitor inflammatory activity in the disease more accurately.

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