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.