Revealing Microvascular Involvement in Pediatric Localized Scleroderma Through Nailfold Capillaroscopy

Area of Science:

• Pediatric rheumatology
• Dermatology
• Vascular biology

Background:

• Juvenile localized scleroderma (jLoS) is a chronic inflammatory condition affecting skin and subcutaneous tissues.
• Microvascular changes are implicated in the pathogenesis of jLoS.
• Early detection of vascular alterations is crucial for managing jLoS.

Purpose of the Study:

• To investigate microvascular alterations in children with jLoS using nailfold capillaroscopy (NFC).
• To compare capillaroscopic findings between jLoS patients and healthy controls.
• To assess the utility of NFC as a diagnostic tool for jLoS.

Main Methods:

• A case-control study involving 13 children with jLoS and 16 healthy controls.
• Nailfold capillaroscopy (NFC) was performed to assess capillary density, tortuosity, dilatation, disorganization, branching, and neoangiogenesis.
• Disease activity (mLoSSI), damage (LoSDI), and functional status (6MWT) were evaluated.

Main Results:

• jLoS patients showed significantly increased tortuosity, dilatation, and neoangiogenesis compared to controls (p < 0.05).
• Capillary density, length, and disorganization scores were higher in jLoS patients, with a lower intercapillary distance (p < 0.05).
• No avascular areas or giant capillaries were observed; Microangiopathy Evaluation Scores (MES) were similar between groups.

Conclusions:

• NFC is a valuable non-invasive tool for detecting microvascular alterations in pediatric localized scleroderma.
• The study confirms significant capillaroscopic abnormalities in children with jLoS.
• Findings support the role of microvascular changes in jLoS pathogenesis and NFC's utility in early assessment.