A Cross-Sectional Study of Nailfold Capillary Changes in Psoriasis

Abstract

Background: Microcirculation in the skin of psoriasis patients significantly differs from unaffected individuals. Vascular changes precede skin lesions and occur even in nonlesional skin. Aims: The primary aim of this work was to study the nailfold capillary changes in psoriasis patients, and to compare it with that of controls. The secondary aim of this work was to compare the nailfold capillary changes in psoriasis patients with and without nail changes. Methods: A comparative cross-sectional study of 40 psoriasis patients and 40 age and sex-matched controls analyzed the capillaries of the proximal nailfold of all fingers using a dermoscope. The mean capillary loop density/mm, tortuous capillaries, capillary hemorrhages, and avascular areas were assessed. Results: The mean nailfold capillary loop density in psoriasis (6.98 ± 0.54 per mm) was significantly less than that in controls (8.01 ± 0.61 per mm) ( P < 0.001). Avascular areas in the nailfold of psoriasis patients (55%) were significantly more than the same in controls (22.5%) ( P = 0.003). Of 40 psoriasis patients, 26 had nail psoriasis. Of this, 19 (73%) had avascular areas ( P = 0.002). No significant association of nailfold capillary density or avascular areas with disease duration or severity was noted. An increase in tortuous capillaries and nailfold hemorrhages noted in psoriasis was not significant. Limitations: Small sample size, not having participants with psoriatic arthropathy, and lack of information on capillary diameter and capillary changes in hyponychium were the limitations. Conclusion: The reduced mean capillary loop density, and higher frequency of avascular areas noted in cases compared to controls, points to a pathogenic role for microvascular damage in psoriasis. Whether the lack of association of these changes with disease duration and severity suggests the possibility of these being early disease markers for psoriasis, needs further analysis in larger prospective studies.

Dermoscopic Features of Psoriatic Nails and Their Correlation to Disease Severity

“…Separation of the nail plate and nail bed is often referred to as onycholysis [ 12 ]. A linear erythematous border around the onycholytic areas can be specifically seen by dermoscope which is rarely observed by the naked eye and can be considered a specific onycholysis finding in psoriatic nails [ 13 ].…”

“…A score of 72 is the highest that could be achieved and demonstrates a 100% body afection with psoriasis while zero (0) score is the lowest that can be achieved and demonstrates no skin involvement. PASI scores can be divided into mild (below 10); moderate (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20); and severe if above 20 [6].…”

Non-invasive techniques to access in vivo the skin microcirculation in patients

“…Nailfold videocapillaroscopy has been used to investigate the microcirculation in rheumatological or dermatological diseases such as systemic lupus erythematosus ( 11 , 35 ), primary Sjögrens’s Syndrome ( 36 ), systemic sclerosis ( 37 ), and psoriasis ( 38 , 39 ). As peripheral microcirculation can mirror vascular diseases, important research has been developed with Diabetes Mellitus ( 40 ), coronary artery disease ( 41 , 42 ), and arterial hypertension ( 43 ) as well.…”

“…Atherosclerosis, high blood pressure, heart disease, Diabetes Mellitus, and kidney failure have been studied by LDF or LSCI ( 44 ). Some diseases have been studied by many methods, for example Systemic Sclerosis by NVC ( 37 ), Laser Doppler Flowmetry ( 45 ) and LSCI ( 46 ) or psoriasis by NVC ( 38 , 39 ) and LSCI ( 47 ).…”

Blood flow characterization in nailfold capillary using optical flow-assisted two-stream network and spatial-temporal image

“…There are significant abnormalities in capillary morphology in patients with hepatitis B and hepatitis C [6]. The mean capillary loop density in psoriasis was significantly less than that in normal [7]. Decreased capillary density, telangiectasia, and the appearance of giant capillaries are characteristics of patients with systemic sclerosis [8].…”