Molecular insights from skin biopsies: Deciphering microvascular pathology in peripheral vascular diseases

doi:10.5493/wjem.v15.i4.111043

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World Journal of Experimental Medicine

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2220-315x

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Systematic Reviews

World J Exp Med. Dec 20, 2025; 15(4): 111043
Published online Dec 20, 2025. doi: 10.5493/wjem.v15.i4.111043

Molecular insights from skin biopsies: Deciphering microvascular pathology in peripheral vascular diseases

Maneesha Kumari, Narainder Kumar, Rahol Meghwar, Rahul Rai, FNU Rahul, Muhammad Ali Hassan, Kapeel Kumar, Hanesh Kumar, Muhammad Hashir Naveed Chaudhary, Kainaat Zahid, Farah Alam, Inshal Jawed, Danaish Kumar, Shafaq Jabeen, Umair Qadir, Rabia Asim

Maneesha Kumari, Department of Medicine, Peoples University of Medical and Health Sciences, Nawabshah 67480, Sindh, Pakistan

Narainder Kumar, Rahol Meghwar, Rahul Rai, Kapeel Kumar, Department of Medicine, Liaquat University of Medical and Health Sciences, Jamshoro 76090, Sindh, Pakistan

FNU Rahul, Department of Medicine, Chandka Medical College, Larkana 77170, Sindh, Pakistan

Muhammad Ali Hassan, Department of Medicine, Avicenna Medical College, Lahore 53100, Punjab, Pakistan

Hanesh Kumar, Department of Medicine, Hubei University of Arts and Sciences Medical College, Xiangyang 441053, Hubei Province, China

Muhammad Hashir Naveed Chaudhary, Department of ENT, East Cheshire NHS Trust, Macclesfield SK10 3BL, Cheshire East, United Kingdom

Kainaat Zahid, Farah Alam, Department of Medicine, DOW Medical College, Karachi 74200, Sindh, Pakistan

Inshal Jawed, Umair Qadir, Department of Medicine, Dow University of Health Sciences, Karachi 75300, Sindh, Pakistan

Danaish Kumar, Shafaq Jabeen, Department of Medicine, Karachi Medical and Dental College, Karachi 74700, Sindh, Pakistan

Rabia Asim, Department of Internal Medicine, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi 78200, Sindh, Pakistan

Author contributions: Kumari M and Kumar N conceived and designed the study; Kumar M, Kumar N, and Meghwar R drafted the initial manuscript; Kumar N, Meghwar R, Rai R, and Rahul F performed the initial study screening and selection; Kumar N, Meghwar R, Rai R and Jabeen S conducted the comprehensive literature search and database queries; Meghwar R, Hassan MA, and Kumar K conducted the data extraction and quality assessment using the Cochrane risk of bias tool and Newcastle-Ottawa Scale; Rai R, Kumar K, Kumar H and Zahid K performed the data synthesis and analysis; Rai R, Hassan MA, Kumar K, Chaudhary MHN and Jawed I critically reviewed and revised the manuscript for important intellectual content; Alam F, Kumar D, Qadir U and Asim R revised the manuscript; all authors approved the final version of the manuscript and agreed to be accountable for all aspects of the work.

Conflict-of-interest statement: The authors declare no conflicts of interest or financial interests related to the content of this manuscript.

PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Inshal Jawed, Chief Physician, Senior Researcher, Department of Medicine, Dow University of Health Sciences, Baba-E-Urdu Road, Karachi 75300, Sindh, Pakistan. inshaljwd@gmail.com

Received: June 23, 2025
Revised: July 23, 2025
Accepted: October 29, 2025
Published online: December 20, 2025
Processing time: 180 Days and 22.9 Hours

Abstract

BACKGROUND

The heterogeneous group of disorders called peripheral vascular diseases (PVDs) occurs outside the heart and brain tissue to cause ischemia and severe health complications. Diagnosis accuracy is essential in starting appropriate patient management at the proper time. Modern medicine considers skin biopsies crucial diagnostic tools that yield histopathological and molecular evidence for examining PVD-related microvascular changes.

AIM

To evaluate skin biopsy applications in PVD diagnostics through artistic analysis of technical processes and examination of pathological and innovative molecular indicators.

METHODS

A systematic review of randomized controlled trials and original studies about skin biopsy utility in PVD diagnosis used PubMed, Scopus, and EMBASE search platforms. The reviewed studies met specific entry requirements, while all case reports and review articles remained excluded.

RESULTS

A total of 22 studies suited the research criteria that were evaluated. Researchers emphasized the value of skin biopsies for identifying inflammatory from non-inflammatory PVDs. At the same time, they detect systemic sclerosis and diabetic vasculopathy abnormalities of micro-vessels and identify endothelial dysfunction through measurements of vascular endothelial growth factor and intercellular adhesion molecule-1 and endothelial nitric oxide synthase markers. Skin biopsies require further improvement because they cause patient discomfort and produce variable diagnostic results that specialists must interpret.

CONCLUSION

Skin biopsies enable essential diagnostic findings about PVD and improve patient detection. The development of standardized biopsy procedures and molecular diagnosis techniques should be studied to advance PVD diagnoses in clinical practice.

Keywords: Peripheral vascular diseases; Skin biopsy; Microvascular pathology; Molecular markers; Histopathology

Core Tip: The systematic review highlights the crucial role of skin biopsies in the diagnosis of peripheral vascular diseases, particularly in terms of histopathological and molecular investigations. The study of skin biopsies is highly informative in understanding diseases in terms of microvascular pathology, endothelial dysfunction, and inflammation, such as systemic sclerosis, diabetic vasculopathy, and vasculitis. The incorporation of molecular markers, such as vascular endothelial growth factor, intercellular adhesion molecule-1, and endothelial nitric oxide synthase, highlights the potential of skin biopsies in enhancing diagnostic accuracy and stratifying patients. Nonetheless, some difficulties related to the standardization of both biopsy and molecular testing remain, which necessitate additional studies to apply it in practice.