Dermoscopic detection of nail fold capillary abnormality in patients with systemic sclerosis

Ohtsuka, Tsutomu

doi:10.1111/j.1346-8138.2011.01357.x

Cited by 15 publications

(10 citation statements)

References 22 publications

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“…24 Ohtsuka evaluated 62 patients of SSc with dermoscope and found higher incidence of dilated capillaries (43.5%), avascular areas (25.8%), and nailfold bleeding (12.9%). 25 Similar patterns may be found in patients with other connective tissue diseases (eg., dermatomyositis, SLE, and MTCD). In primary Raynaud's phenomenon, capillaroscopy is normal, however, those associated with connective tissue disease show capillaroscopic alterations.…”

Section: Ijdysupporting

confidence: 63%

A Cross-sectional Descriptive Study of Dermoscopy in various Nail Diseases at a Tertiary Care Center

Chatterjee¹,

Neema²,

Rathod³

et al. 2017

International Journal of Dermoscopy

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Introduction Nail diseases may often possess a challenge for the treating dermatologist, as they may primarily be affected without any skin involvement and sometimes may present with subtle changes which can be easily missed by the naked eye. The macroscopic nail changes can be assessed very well with a naked eye, however, the important minutiae may be assessed with a dermoscope. Aim To study the characteristic dermoscopic findings in various nail diseases. Materials and methods A total of 250 patients (males-130, females-120) with clinically evident nail diseases were enrolled in this cross-sectional descriptive study. After a thorough clinical examination, patients were subjected to dermoscopic examination of all 20 nails. Chi-square test or Fisher's exact test (in a very few patients of nail diseases) were used for statistical analysis, with a significance threshold of p < 0.05. Results Nail psoriasis (n = 45) was the commonest nail disease found in which the most common dermoscopic feature was circular punctate depressions (64.5%). Onychomycosis (n = 40) was the next common disease in which yellowish discoloration (100%) was commonly seen in all patients and rough scaly surface (100%) in the total dystrophic type. In pitted keratolysis (n = 19) transverse brown bands (57.9%) were most commonly seen as was the case in eczemas. Lichen planus (n = 14) was associated with longitudinal fissuring (64.3%) most commonly. Trachyonychia (n = 5) was associated with longitudinal fissuring (100%) in all cases. The most common dermoscopic feature of alopecia areata (n = 4) was circular punctate depressions (75%). Systemic scleroderma (n = 4) typically showed giant capillaries (75%) as the most common feature. Conclusion A meticulous search with the dermoscope, furnishes minuscule details of the nail unit that can be diagnostic of several nail diseases at an early stage before dystrophy sets in. However, further studies are required to validate these findings. Clinical significance Dermoscopy is a noninvasive complementary tool which aids in diagnosis of nail diseases more quickly and can also be used for monitoring the evolution, therapeutic response, and prognosis of these diseases. How to cite this article Rathod D, Makhecha MB, Chatterjee M, Singh T, Neema S. A Cross-sectional Descriptive Study of Dermoscopy in various Nail Diseases at a Tertiary Care Center. Int J Dermoscop 2017;1(1):11-19.

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Section: Ijdysupporting

confidence: 63%

A Cross-sectional Descriptive Study of Dermoscopy in various Nail Diseases at a Tertiary Care Center

Chatterjee¹,

Neema²,

Rathod³

et al. 2017

International Journal of Dermoscopy

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“…To the best of our knowledge, this is the first study to compare NFC abnormalities among CTDs and the normal population with this method. Although information regarding the comparison of NFC features in patients with autoimmune CTDs vs. healthy controls has been previously reported in Caucasian and Japanese individuals (44,45), there is no data in the Southeast Asian population. We confirm that numerous onychoscopic microvascular parameters in the morphologic indexes (i.e., bushy capillaries, elongated capillaries, subpapillary plexus, and hemorrhage), diameter patterns (i.e., enlarged capillaries), architectural forms (i.e., disorganized and avascular pattern), and decreased capillary density were distinct features for CTDs and rarely seen in normal individuals.…”

Section: Discussionmentioning

confidence: 99%

Nailfold Capillaroscopy With USB Digital Microscopy in Connective Tissue Diseases: A Comparative Study of 245 Patients and Healthy Controls

et al. 2021

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Background: Nailfold capillaroscopy (NFC) is a valuable tool to detect microcirculation abnormalities in connective tissue diseases (CTDs). However, whether the universal serial bus (USB) digital microscopy used as onychoscopy is as effective as the videocapillaroscopy in determining the diagnostic and prognostic values of CTDs remains to be determined.Objective: This study aims to investigate NFC features of systemic lupus erythematosus (SLE), dermatomyositis (DM), and systemic sclerosis (SSc) patients and compare with normal controls as well as examine which feature could differentiate among CTDs. Furthermore, we aim to explore different capillaroscopic abnormalities and their association with disease activity.Methods: Nailfold images were taken from patients and healthy controls using a USB digital microscopy. Patterns on the capillary morphology, diameter, architecture, and density were recorded and compared. We further determined the NFC findings in SLE, DM, and SSc and corresponded to their respective disease activity scoring system.Results: A total of 245 participants, consisting of 54 SLE, 32 DM, and 51 SSc patients, as well as 108 controls, were enrolled. All capillaroscopic features, except for tortuous capillaries, were significantly more common in CTDs than healthy control (all p < 0.05). A multinomial logistic regression analysis revealed that bushy capillaries had significantly higher odds for both SLE and DM than SSc (OR: 4.10, 95% confidence interval (CI): 1.71–9.81, p = 0.002 and OR: 7.82, 95% CI, 2.86–21.38, p < 0.001, respectively). Elongated capillaries demonstrated significant odds for SLE compared with SSc (OR: 3.35, 95% CI: 1.005–11.20, p = 0.049), while prominent subpapillary plexus showed greater odds for SLE compared with both DM and SSc (OR: 2.75, 95% CI: 1.07–7.02, p = 0.03 and OR: 5.78, 95% CI: 2.29–14.58, p < 0.001, respectively). The presence of hemorrhage, enlarged capillaries, and the low-density index had significantly higher odds in favor of SSc than SLE. Bushy capillaries were the only pattern with a strong association for DM over SSc. The presence of enlarged capillaries indicated higher SLE severity, but no specific finding was related to DM or SSc skin scores.Conclusions: Nailfold capillaroscopic examination using a digital microscope is a valuable method for the diagnosis of SLE, DM, and SSc. Several morphologic patterns can help differentiate among CTDs; however, the prognostic significance of this method requires further investigations.

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“…13 Some studies showed dilated capillaries, nail-fold bleeding, and avascular areas to be common in patients with SLE. 14 The incidence of microhemorrhages was significantly higher in patients with active SLE disease, triggered by vasospasm, vasculitis, or thromboembolism. 15 Tunc et al reported subungual hemorrhaging was found in the fingernails of 11 of 28 (39.3%) patients with active SLE.…”

Section: Discussionmentioning

confidence: 91%

Longitudinal melanonychia and subungual hemorrhage in a patient with systemic lupus erythematosus treated with hydroxychloroquine

Zhang

Liu

Cai

et al. 2018

Lupus

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Hydroxychloroquine is an antimalarial agent, most commonly prescribed in the treatment of several rheumatic diseases. Although generally well tolerated, a variety of mucocutaneous adverse effects have been reported. Besides the familiar adverse effects, longitudinal melanonychia is rarely seen. Although the incidence is extremely low, systemic lupus erythematosus may also cause nail pigmentation in its own right. We report the case of a 55-year-old woman who was diagnosed with systemic lupus erythematosus and presented with longitudinal melanonychia of all 10 fingernails after 3 years of treatment with hydroxychloroquine, without mucocutaneous hyperpigmentation. The pigment of the nail lasted for more than 15 years. To the best of our knowledge, this is first published report of hydroxychloroquine-induced melanonychia without mucocutaneous hyperpigmentation. This case demonstrates that hydroxychloroquine treatment and the primary disease should be considered in the case of multiple nail changes in patients with systemic lupus erythematosus.

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Dermoscopic detection of nail fold capillary abnormality in patients with systemic sclerosis

Cited by 15 publications

References 22 publications

A Cross-sectional Descriptive Study of Dermoscopy in various Nail Diseases at a Tertiary Care Center

A Cross-sectional Descriptive Study of Dermoscopy in various Nail Diseases at a Tertiary Care Center

Nailfold Capillaroscopy With USB Digital Microscopy in Connective Tissue Diseases: A Comparative Study of 245 Patients and Healthy Controls

Longitudinal melanonychia and subungual hemorrhage in a patient with systemic lupus erythematosus treated with hydroxychloroquine

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