Trichoscopic, oral, and periungual fold findings as activity and damage markers in dermatomyositis patients and their correlation with myositis antibodies

Abstract

There is little clarity about the clinical manifestations of dermatomyositis (DM) in the periungual folds, scalp, and oral cavity and their association with disease activity and damage. The objective of this study was to compare the prevalence of trichoscopic, oral, and periungual changes between DM and healthy patients and assess their possible association with disease activity and damage. We conducted an observational, transversal, and analytical study between 2020 and 2021. Forty DM patients were matched by sex and age with 40 healthy individuals. On the same day, all patients had a clinical evaluation of the hands, periungual folds, scalp, and oral cavity. Photographs of these areas and peripheral venous blood tests, including myositis-associated (MAAs) and myositis-specific antibodies (MSAs), were taken. Two dermatologists blinded to their diagnosis, damage, and activity levels registered the lesions. The disease activity and damage were evaluated using the Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI). The presence of mechanic’s hands, Gottron’s sign, and Gottron’s papules in hands; capillary dilation, capillary tortuosity, cuticular hemorrhage, avascular areas, and cuticular hyperkeratosis in periungual folds; thick tortuous capillaries in scalp; gingival telangiectasias in the oral cavity; and positive MSAs associated with severe cutaneous involvement in DM patients (Anti-TIF1g, Anti-MDA5, Anti-SAE1/2) were associated with a higher CDASI activity score. The presence of MSAs associated with intense muscle involvement in DM patients (Anti-Mi2a, Anti-Mi2b, Anti-NPX2, and Anti-SAE1/2) was related to a lower CDASI activity score. Gottron’s sign and Gottron’s papules in hands; capillary dilation, capillary tortuosity, cuticular hemorrhage, avascular areas, and cuticular hyperkeratosis in periungual folds; basal erythema in scalp; and gingival telangiectasias in the oral cavity were associated with a higher CDASI damage score. There are trichoscopic, oral and periungual fold findings and some myositis-specific antibodies that correlate with disease activity and damage in DM patients. Supplementary Information The online version contains supplementary material available at 10.1007/s00403-023-02554-0.

Oral findings as a clinical tool to differentiate between lupus erythematosus and dermatomyositis patients

“…However, both studies were retrospective and analyzed only symptomatic oral ulcers, compared to our recently published work, which described all the trichoscopic, oral, and periungual fold ndings in 40 DM patients, whether symptomatic or not. In addition, in that study we explained that all the DM patients had at least one oral manifestation and, compared with 40 healthy individuals matched by sex and age, DM patients had a statistically more frequent presence of red macules in the palate, gingivitis, gingival cobblestones, gingival telangiectasias, and palatal telangiectasias and those gingival telangiectasias were associated with higher activity and damage scores in patients with DM measured by the Cutaneous Dermatomyositis Disease Area and Severity Index, rea rming that the oral exam is essential (71).…”

“…However, in many DM patients they are negative and false positives are relatively common (80). For (71). All these differences are probably explained by genetic and environmental variations, the low sample size, limited access, high cost of these tests, and differences in sensitivity depending on the assay used.…”

Idiopathic inflammatory myopathies: one year in review 2023

“…The frequency of dilated capillaries at baseline was higher in patients with anti-TIF1γ antibodies compared to those with anti-synthetase antibodies, and reduced capillary density was also more prevalent in anti-TIF1-positive patients compared to those with anti-MDA5 or anti-synthetase antibodies (60). Both dilated capillaries and reduced density improved after disease stabilisation in patients with anti-MDA5 antibodies (60), but not in patients with anti-TIF1γ or anti-synthetase antibodies (59). A significant reduction in haemorrhages was observed in all three groups (60).…”

“…In DM, more frequent are mechanic's hands, Gottron's sign and Gottron's but also poikiloderma, tufted hair, telangiectasias and erythema on the scalp. Gingival cobblestones, gingival telangiectasias, and palatal telangiectasias can be found on the oral cavity (59).…”

“…It is known that capillaroscopic and cutaneous alterations exist in patients with DM, however, abnormalities at the level of the scalp and oral mucosa have been explored only at a limited extent, also because they are usually less frequent and less visible. Salguiero et al (59) conducted the first study that compare trichoscopic, oral and periungual findings between DM and healthy patients. Obviously, in DM were more frequent mechanic's hands, Gottron's sign and Gottron's papules as well as capillary dilations and tortuosity, cuticular haemorrhage and hyperkeratosis, avascular areas.…”