CLINICAL AND DERMOSCOPIC CHARACTERISTICS OF NAIL AND NAILFOLD CAPILLARY CHANGES IN AUTOIMMUNE CONNECTIVE TISSUE DISORDERS

Abstract

Background: Nail and nailfold capillary changes are common in autoimmune connective tissue
disorders(AICTD). Vascular changes and abnormalities caused by these disorders can result in
various visible skin manifestations and also few nail changes. These nailfold capillary changes
can be easily observed using capillaroscope or video dermoscopes but these instruments are
expensive and difficult to operate. Alternatively, handheld dermoscope is easy to use and
affordable and hence can be used for examining these changes. By using handheld dermoscope and smartphone, these changes can be examined. Hence both clinical and dermoscopic pictures can be documented.
Objectives:To describe clinical nail changes in connective tissue disorders and to describe the
dermoscopic findings of nailfold capillary changes in these disorders.
Materials and methods:Total of 74 patients[systemic lupus erythematosus (SLE), Scleroderma(SSc),discoid lupus erythematosus(DLE), Rheumatoid arthritis(RA),
Dermatomyositis (DM)] diagnosed of AICTD were examined for nail changes and nailfold
capillary changes using Dermlite DL4 dermoscope in the outpatient department of dermatology, at tertiary care teaching hospital.
Results: Out of 74 subjects, 8(11.8%) were males,66(89.2%) were females. Mean age of study
participants was 43.1±13.8.The most common AICTD was SLE-43(58.10%) followed by SSc14(18.91%),DLE-7(9.45%),RA-6(8.10%) and DM-4(5.4%) Clinical nail changes seen were
longitudinal ridging(18.9),periungual erythema(37.8%),nail plate pigmentation(37.8%),subungual hyperkeratosis(27%),dyschromia of proximal nail
fold(31.1%),cuticle damage(35.1%). Dermoscopic nail fold capillary changes seen were:
enlarged capillaries(66.2%),loss of capillaries(27%),disorganized capillaries(68.9%),twisted
capillaries(29.7%) and capillary hemorrhages(28.7%). Nail fold capillary changes were more
common and prominent in cases of scleroderma and dermatomyositis and few cases of  rheumatoid arthritis. Nail plate pigmentation and periungual erythema was most commonly seen in these group of disorders.
Conclusion: Handheld dermoscope can be used to identify nail fold capillary changes and
images can be documented with the help of smartphone. Regular usage of dermoscope should be practised in these autoimmune connective tissue disorders.