Diagnostic Utility of Nailfold Capillaroscopy using Hand-held Dermoscope in Systemic Sclerosis

Abstract

Introduction: The pathogenesis in systemic sclerosis (SSc) mainly involves vascular injury, fibrosis, and immune activation. Visualization of these microvascular changes by nailfold capillaroscopy (NFC) can help in the early diagnosis of the disease. Even though the gold standard for NFC is a videodermoscope, the ease, practicality, and accessibility make the hand-held dermoscope a more versatile and suitable device in the hands of the dermatologists in the busy outpatient department.

Aim: To study the pattern of nail fold capillaries using hand-held dermoscope in the patients of SSc and correlate the findings with disease severity.

Materials and methods: An observational, cross-sectional hospital-based study was carried out over a span of 2 years, from January 2020 till December 2021, in 50 patients of SSc. NFC using DermLite DL4 was performed in all the patients and distribution, morphology, density of capillaries, and nail fold capillary pattern were observed.

Results: Out of 50 patients, 38 patients had diffuse type of disease, and 12 had limited type of disease. The mean capillary density in our patients was 4.7 ± 0.81/mm. Dilated capillaries was the most common NFC finding (80%), whereas active scleroderma pattern was the most common pattern (56%). A significant association was found between the type of capillary pattern and duration of disease, type of disease, and cutaneous manifestations.

Conclusion: Hand-held dermoscope is reliable, practical, and assessable tool that aids in early diagnosis of the disease and also helps in assessing the severity and prognosis of SSc.

Keywords: Hand-held dermoscope; nailfold capillaroscopy; systemic sclerosis.

Figure 1

Hand-held dermoscope, universal adapter, charging cable and a mobile phone. (Right to left)

Figure 2

Normal proximal NFC seen as regular hairpin bends (yellow arrow). Polarized non-contact mode DermLite DL4, ×10

Figure 3

Measuring NFC density using scale on the hand-held dermoscope. Polarized non-contact mode, DermLite DL4, ×10

Figure 4

NFC showing dilated capillaries (blue arrow). Polarized non-contact mode, DermLite DL4, ×10

Figure 5

(a) NFC in a patient of SSc showing isolated dilated capillary loops (blue circle) with few hemorrhages (yellow arrow)-Early SD pattern. Polarized non-contact mode, DermLite DL4, ×10. (b) Dilated capillaries visualized with an unaided eye. (c) NFC in a patient of SSc showing giant capillaries (blue circle), frequent hemorrhages (black arrow), moderate loss of capillaries (yellow star) and mild disorganization – Active SD pattern. Polarized non-contact mode, DermLite DL4, ×10. (d) NFC in a patient of SSc showing severe loss of capillaries with extensive avascular areas (yellow star) with few megacapillaries (blue circle) – Late SD pattern. Polarized non-contact mode, DermLite DL4, ×10