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. 2022 Oct;7(3):197-203.
doi: 10.1177/23971983221102688. Epub 2022 Jun 5.

Effect of skin phototype on quantitative nailfold capillaroscopy

Devender Bairwa  1 , Chengappa G Kavadichanda  1 , Saikumar Dunga  1 , Anoop Mathew  1 , Aishwarya G  1 , Gayathri M S  1 , Gorijavolu Mamatha  1 , Molly Mary Thabah  1 , Vir Singh Negi  2
Affiliations

Effect of skin phototype on quantitative nailfold capillaroscopy

Devender Bairwa et al. J Scleroderma Relat Disord. 2022 Oct.

Abstract

Objectives: To determine the impact of Fitzpatrick scale-based skin phototype on visualization of capillary density using nailfold capillaroscopy in healthy Indian adults.

Methods: In this cross-sectional study, healthy adults were examined for nailfold capillaroscopy findings utilizing a portable capillary microscope at 800× magnification. Photographs of two contiguous areas measuring 1 mm2 each of the distal row of capillaries were captured. Images were captured from the central area of all fingers except thumb in both hands. Capillary density and morphology of nailfold capillaroscopies were assessed by two blinded assessors. The nailfold capillaroscopy parameters were compared between the Standard Fitzpatrick scale-based skin phototypes.

Results: A total of 118 healthy adults were enrolled in the study. Type III, IV, V, and VI skin phototypes were seen in 27 (22.90%), 32 (27.19%), 29 (24.58%), and 30 (25.42%) participants, respectively. All participants (100%) had normal nailfold capillaroscopy morphology and architecture. Zero capillaries were visible in 11 fingers among 5 patients (4.24%) and all of them had Type VI phototype. The median capillary density per mm was 5.19 (interquartile range = 4.37-6.75) with 90 (76.27%) participants having less than seven capillaries. The median average capillary density was significantly different (p-value < 0.0001) across Type III (8.13, interquartile range = 6.44-8.88), Type IV (5.67, interquartile range = 4.41-6.98), Type V (4.94, interquartile range = 4.19-5.38), and Type VI (4.53, interquartile range = 3.72-4.91) phototypes (p < 0.05).

Conclusion: The number of capillaries visualized during nailfold capillaroscopy decreases as the skin pigmentation increases. There is a need to redefine the nailfold capillaroscopy density and avascularity by taking skin phototype as one of the determinants before labeling a nailfold capillaroscopy finding with less visualized capillaries as abnormal.

Keywords: Nailfold capillaroscopy; avascularity; microvasculature; skin pigmentation.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Comparison of median nailfold capillary density per mm across the healthy participants with different Fitzpatrick skin type: (a) Type III, (b) Type IV, (c) Type V, and (d) Type VI. Each picture represents 1 mm2 nailfold area at 800× magnification.
See this image and copyright information in PMC

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