GD06: Nailfold dermoscopy in patients with autoimmune connective tissue disorders: a case–control study on Fitzpatrick skin type IV–V

Balendran Thanushah,¹ Akhila Nilaweera,² Savidya Appuhamy³ and Shanmuganathan Prashanth⁴

¹Base Hospital Muthur, Muthur, Sri Lanka; ²Faculty of Medicine, University of Colombo, Colombo, Sri Lanka; ³Teaching Hospital, Batticaloa, Batticaloa, Sri Lanka; and ⁴National Hospital of Sri Lanka, Colombo, Sri Lanka

Nailfold microangiopathic changes are established findings in patients with autoimmune connective tissue disorders, particularly systemic sclerosis, systemic lupus erythematosus (SLE), dermatomyositis and mixed connective disorders (MCTD). These changes are well visualized by nailfold capillaroscopy, but it requires special equipment and is relatively time consuming. Although images cannot be as clearly visualized as in nailfold capillaroscopy, dermoscopy can be used as a bedside test to assess nailfold changes. As skin type IV and above are pigmented skin types, assessing nailfold vascular abnormalities are not equally as visible as in lighter skin types. Sri Lankans’ skin type commonly falls under Fitzpatrick skin type IV or higher. The aim was to assess finger nailfold capillary changes of patients with autoimmune connective tissue disorders with Fitzpatrick skin type IV and above and to assess the correlation between the presence of Raynaud syndrome, a diagnosis of connective tissue disorder and nailfold dermoscopy findings. A case–control study was carried out at Teaching Hospital, Batticaloa, Sri Lanka among patients with a diagnosed autoimmune connective tissue disorder for a period of 1 year. Nailfold changes of 25 patients and 50 age- and sex-matched healthy controls were examined using a handheld Dermlite DL4. Of the 25 patients, 16 had systemic lupus erythematosus (SLE), four had diffuse systemic sclerosis, two had dermatomyositis, and one had CREST syndrome, mixed connective tissue disorder and overlap syndrome. Raynaud syndrome was present in 10 patients. Thirteen patients had abnormal nailfold capillaries, whereas 12 had normal nailfold changes. Observed abnormal morphology of capillaries included dilated hairpin-like vessels (n = 9; 36%), tortuous capillaries (n = 8; 32%), bizarre capillaries (n = 9; 36%) and meandering capillaries (n = 8; 32%). In addition, microhaemorrhages (n = 8; 32%), avascular areas (n = 4; 16%) and capillary dropouts (n = 4; 16%) were also noted. The architecture of the vessels was disorganized in six (24%), and the diameter of the vessels was regularly enlarged in a single patient (4%) and irregularly enlarged in seven (28%). Six patients were concluded as having nonspecific abnormalities in nailfold dermoscopy. Four patients had active scleroderma pattern, two had late scleroderma pattern and one had early scleroderma pattern on dermoscopy. Dermoscopic findings of a scleroderma pattern was statistically significantly associated with the clinical diagnosis being diffuse systemic sclerosis (P < 0·05) but not with a clinical diagnosis of SLE (P > 0·05). Nailfold changes were not significantly associated with the severity of SLE, according to SLE Disease Activity Index score (P > 0·05). The presence of Raynaud syndrome was not significantly associated with nailfold dermoscopic changes. Nailfold dermoscopic findings are comparable with nailfold capillaroscopic changes. In skin of colour, normal nailfold changes may not clearly be visible by dermoscopy. But abnormal microangiopathic changes can be clearly visualized. Considering the availability of standard capillaroscopy, dermoscopy should be incorporated in the assessment of patients with an autoimmune connective tissue disorder.