Skip to main content

Advertisement

SpringerLink
Log in

Comparison of vascular endothelial growth factor expression between lesional and non-lesional skin in patients with morphea: a dermoscopy-guided immunohistochemical study

  • Original Paper
  • Published:
Archives of Dermatological Research Aims and scope Submit manuscript

Abstract

Morphea is an inflammatory fibrosing disease, initiated by vascular injury resulting in increased collagen formation and decreased collagen degradation. This study was designed to evaluate the role of angiogenic vascular endothelial growth factor (VEGF) in the vascular changes which are dermoscopically evident in morphea lesions, compared with that in non-lesional skin, by assessing its expression immunohistochemically on tissue blood vessels. Twenty patients with morphea were subjected to clinical and dermoscopic examinations. Two skin biopsies from lesional and non-lesional skin were obtained and stained with hematoxylin and eosin (H&E) and immunohistochemically with VEGF. Dermoscopic examination showed linear blood vessels in 90% of the lesions. No significant difference in the number of VEGF-stained and unstained blood vessels, was observed between the lesional and non-lesional skin (p = 0.475 and 0.191, respectively). A weak inverse correlation was found between the total number of blood vessels positive for VEGF and the disease duration, (r =  − 0.48; p = 0.032). Significant differences were found between different stages of morphea and total number of blood vessels negative for VEGF, (p = 0.017). In conclusion, VEGF immunostaining, which represents the newly formed blood vessels, showed no difference between lesional and non-lesional skin in patients with morphea. Thus, the dermoscopically observable blood vessels in lesions compared with non-lesional skin are not due to angiogenesis, but rather due to the thinning and atrophy of the overlying epidermis in morphea cases, rendering the blood vessels more obvious.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Abbas L, Joseph A, Kunzler E, Jacobe HT (2021) Morphea: progress to date and the road ahead. Ann Transl Med 9(5):437

    Article  CAS  Google Scholar 

  2. Bao P, Kodra A, Tomic-Canic M, Golinko MS, Ehrlich HP, Brem H (2009) The role of vascular endothelial growth factor in wound healing. J Surg Res 153(2):347–358

    Article  CAS  Google Scholar 

  3. Bhat YJ, Akhtar S, Hassan I (2019) Dermoscopy of Morphea. Indian Dermatol Online J 10(1):92–93.

  4. Bosseila M, Sayed Sayed K, El-Din Sayed SS, Abd El Monaem NA (2015) Evaluation of angiogenesis in early mycosis fungoides patients: dermoscopic and immunohistochemical study. Dermatology. 231(1):82–6.

  5. Campione E, Paterno EJ, Diluvio L, Orlandi A, Bianchi L, Chimenti S (2009) Localized morphea treated with imiquimod 5% and dermoscopic assessment of effectiveness. J Dermatolog Treat 20(1):10–13

    Article  CAS  Google Scholar 

  6. Cantatore FP, Maruotti N, Corrado A, Ribatti D (2017) Angiogenesis dysregulation in the pathogenesis of systemic sclerosis. Biomed Res Int 2017:5345673

    Article  Google Scholar 

  7. Careta MF, Romiti R (2015) Localized scleroderma: clinical spectrum and therapeutic update. An Br Dermatol 90(1):62–73.

  8. Cipriani P, Marrelli A, Liakouli V, Di Benedetto P, Giacomelli R (2011) Cellular players in angiogenesis during the course of systemic sclerosis. Autoimmun Rev 10(10):641–646

    Article  CAS  Google Scholar 

  9. Distler O, Distler JH, Scheid A, Acker T, Hirth A, Rethage J et al (2004) Uncontrolled expression of vascular endothelial growth factor and its receptors leads to insufficient skin angiogenesis in patients with systemic sclerosis. Circ Res 95(1):109–116

    Article  CAS  Google Scholar 

  10. El-Zawahry MB, Abdel El-Hameed El-Cheweikh HM, Abd-El-Rahman Ramadan S, Ahmed Bassiouny D, Mohamed Fawzy M (2007) Ultrasound biomicroscopy in the diagnosis of skin diseases. Eur J Dermatol 17(6):469–475

  11. Errichetti E, Lallas A, Apalla Z, Di Stefani A, Stinco G (2017) Dermoscopy of morphea and cutaneous lichen sclerosus: clinicopathological correlation study and comparative analysis. Dermatology 233(6):462–470

    Article  Google Scholar 

  12. Florez-Pollack S, Kunzler E, Jacobe HT (2018) Morphea: current concepts. Clin Dermatol 36(4):475–486

  13. Helmbold P, Fiedler E, Fischer M, Marsch W (2004) Hyperplasia of dermal microvascular pericytes in scleroderma. J Cutan Pathol 31(6):431–440

    Article  Google Scholar 

  14. Lallas A, Kyrgidis A, Tzellos TG, Apalla Z, Karakyriou E, Karatolias A et al (2012) Accuracy of dermoscopic criteria for the diagnosis of psoriasis, dermatitis, lichen planus and pityriasis rosea. Br J Dermatol 166(6):1198–1205

    Article  CAS  Google Scholar 

  15. Low A.H.L., Ng S, Berrocal V, Brennan B, Chan G, Ng S, Khanna D. Evaluation of Scleroderma Clinical Trials Consortium training recommendations on modified Rodnan skin score assessment in scleroderma. Int J Rheum Dis. 2019 Jun; 22(6): 1036–1040.

  16. Mackiewicz Z, Sukura A, Povilenaite D, Ceponis A, Virtanen I, Hukkanen M et al (2002) Increased but imbalanced expression of VEGF and its receptors has no positive effect on angiogenesis in systemic sclerosis skin. Clin Exp Rheumatol 20(5):641–646

  17. Manetti M, Guiducci S, Ibba-Manneschi L, Matucci-Cerinic M (2010) Mechanisms in the loss of capillaries in systemic sclerosis: angiogenesis versus vasculogenesis. J Cell Mol Med 14(6A):1241–1254

    Article  CAS  Google Scholar 

  18. Mertens JS, Seyger MMB, Thurlings RM, Radstake T, de Jong E (2017) Morphea and Eosinophilic fasciitis: an update. Am J Clin Dermatol 18(4):491–512

    Article  Google Scholar 

  19. Pandey AK, Singhi EK, Arroyo JP, Ikizler TA, Gould ER, Brown J et al (2018) Mechanisms of VEGF (vascular endothelial growth factor) inhibitor-associated hypertension and vascular disease. Hypertension 71(2):e1–e8

    Article  CAS  Google Scholar 

  20. Sartori-Valinotti JC, Tollefson MM, Reed AM (2013) Updates on morphea: role of vascular injury and advances in treatment. Autoimmune Dis 2013:467808

  21. Shim WH, Jwa SW, Song M, Kim HS, Ko HC, Kim MB et al (2012) Diagnostic usefulness of dermatoscopy in differentiating lichen sclerous et atrophicus from morphea. J Am Acad Dermatol 66(4):690–691

    Article  Google Scholar 

  22. Zalaudek I, Kreusch J, Giacomel J, Ferrara G, Catricala C, Argenziano G (2010) How to diagnose nonpigmented skin tumors: a review of vascular structures seen with dermoscopy: part I. Melanocytic skin tumors. J Am Acad Dermatol 63(3):361–374; quiz 75–6.

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Department of Dermatology, Faculty of Medicine, Cairo University School of Medicine, Kasr Al Ainy Hospital, Cairo, PO 11956, Egypt

    Manal Bosseila, Amira Okail & Marwah Adly Saleh

  2. Department of Histology, Faculty of Medicine, Cairo University, Cairo, Egypt

    Safinaz Sayed

Authors
  1. Manal Bosseila
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amira Okail
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Safinaz Sayed
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marwah Adly Saleh
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MB: contributed to the research idea, dermoscopic evaluation of the patients, data analysis, writing of the first draft of the manuscript, manuscript revision; SS: performed the histopathological examination of all patients; AO: collected the patients` information, did the dermoscopic examination and collected the patients` biopsies; MAS: contributed to the research idea, revised the manuscript and submitted the manuscript.

Corresponding author

Correspondence to Marwah Adly Saleh.

Ethics declarations

Conflict of interest

None declared.

Ethical approval

This work was approved by the Dermatology Department of Cairo University.

Consent to participate

All patients provided informed consent to participate in this study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bosseila, M., Okail, A., Sayed, S. et al. Comparison of vascular endothelial growth factor expression between lesional and non-lesional skin in patients with morphea: a dermoscopy-guided immunohistochemical study. Arch Dermatol Res 315, 61–66 (2023). https://doi.org/10.1007/s00403-021-02315-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00403-021-02315-x

Keywords

Search

Navigation