The importance of skin manifestations, serology and nailfold (video)capillaroscopy in morphea and systemic sclerosis: current understanding and new insights

Abstract

Since the field around morphea and systemic sclerosis (SSc) is evolving rapidly, this review approaches conventional as well as more recent clinical developments from a dermatological point of view. Skin manifestations are critical in sub‐classifying these diseases ensuring a correct prognosis for these patients. They can be discretely present, and therefore, diagnosis can be challenging sometimes, implicating a thorough dermatological examination is mandatory. Furthermore, a growing amount of dermatologists perform nailfold videocapillaroscopy (NVC), a more recent reliable non‐invasive imaging technique used for in vivo assessment of the microcirculation at the nailfold. After all, specific NVC‐changes are present in a majority of patients with SSc. This way, dermatologists not only take part in the diagnosis process through clinical investigation but also through the use of a modern state of the art imaging technique that is becoming the golden standard in SSc multidisciplinary workup. In this review, current understandings for NVC in morphea and SSc are revised. So far, the role of NVC in the diagnosis/prognosis/classification of morphea patients has not been thoroughly investigated to make proper conclusions. As for SSc, it is well known that NVC contributes to the diagnosis and can make a fundamental difference especially when obvious clinical SSc signs are absent. This review emphasizes the (somewhat underestimated) role of dermatologists in the process of diagnosis and follow‐up, and thus, the difference we can make for our patients and fellow colleagues in the multidisciplinary workup of SSc and morphea.

Rarities in rare: illuminating the microvascular and dermal status in juvenile localised scleroderma. A case series

“…Magnetic resonance imaging (MRI) and cone beam computed tomography (CBCT) are other imaging possibilities with the disadvantages of high costs and invasiveness for young children, not only during examination (MRI) but also because of negative radiation risks (CBCT) (29)(30)(31)(32)(33)(34)(35)(36)(37). Unlike in SSc, where the evaluation of the microcirculation (using non-invasive standardised tools such as nailfold videocapillaroscopy [NVC] and laser speckle contrast analysis [LASCA]) has earned a pivotal role and the evaluation of skin fibrosis using high-frequency ultrasonography (HFUS) and durometry is currently an area of significant research and standardisation efforts, exhaustive reports using these tools in jLoS are non-existent (1,(6)(7)(8)(9)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54). Against this background, we felt it was time to descriptively assess the (structural and functional) characteristics of the microvascular and dermal status in a case series of jLoS patients, using non-invasive standardised research tools (i.e.…”