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

Abstract

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.

Dermoscopy and Trichoscopy in Dermatomyositis—A Cross-Sectional Study

“…The (video)dermoscopic features of skin symptoms in the course of DM have not been extensively studied so far [7][8][9][10][11][12][13][14][15]. Data from the literature point at potential application of (video)dermoscopy in the assessment of nailfolds (capillaroscopy) [7][8][9][10], scalp (trichoscopy) [11,12], filiform papillae of the tongue [13], hand lesions [14], and cutaneous changes in erythrodermic DM [15].…”

“…Capillaroscopy use has great potential in DM, and several studies confirmed the application of handheld dermatoscopes and videodermatoscopes in the assessment of nailfold capillaries [7][8][9][10]. (Video)dermoscopy enables the visualization of "bushy" capillaries, dilated capillaries, nailfold bleedings, and avascular areas.…”

“…In recent years, this method has also been increasingly used in the assessment of inflammatory dermatoses [5,6]. So far, only a few reports have been published on the dermoscopic features of DM [7][8][9][10][11][12][13][14][15].…”

Dermoscopy of Gottron’s papules and other inflammatory dermatoses involving the dorsa of the hands

“…[5][6][7][8][9][10][11][12][13] So far, dermoscopy has been predominantly used for the assessment of nail fold capillaries and proved to be a reliable tool to detect dilated capillaries, 'bushy' capillaries, nail fold bleedings and avascular areas. [5][6][7]11 Dermoscopy has also been utilized for the visualization of filiform papillae of the tongue in connective tissue diseases. 9 Trichoscopic features of DM have also been reported in a few papers.…”

Alopecia Areata: An Autoimmune Disease of Multiple Players

“…Despite the complex disease etiology and our incomplete understanding of the relationship between these factors and hair loss, we presume that genetic predisposition, stress, and environmental factors affect immune activation and influence AA occurrence. [163][164][165][166][167][168][169] Further, novel targeted therapies that treat AA have been reviewed. However, a complete response without relapse remains challenging.…”