Dermatoscopic Assessment of Nail Fold Capillary Patterns in Patients of Color with Different Autoimmune Connective...

Nail fold capillaroscopy is a noninvasive tool for assessing early capillary changes in proximal nail fold capillaries in autoimmune connective tissue diseases. Handheld dermatoscopes have expanded its clinical application.

To characterize nail fold capillary patterns using dermatoscopy and evaluate their association with autoimmune connective tissue disease severity in patients with skin of color (Fitzpatrick skin types IV, V and VI).

A six-month cross-sectional study was conducted at Ghurki Trust Teaching Hospital in Lahore, Pakistan. Ninety-six patients with Fitzpatrick skin types IV-VI and autoimmune connective tissue diseases underwent dermatoscopic evaluation (HEINE DELTA 30 Dermatoscope) and clinical assessment of disease activity.

Most participants were female (84.4%). The diagnoses included rheumatoid arthritis (RA) (51%), systemic lupus erythematosus (SLE) (27%), systemic scleroderma (SSc) (17%), and dermatomyositis (DM) (5%). Capillary patterns varied significantly with disease duration (p = 0.001) and diagnosis. Normal patterns were observed in 27 patients (28.1%), nonspecific patterns in 28 patients (29.2%), and scleroderma patterns in 41 patients (42.7%). Scleroderma patterns were most frequent in those with SSC and SLE. Focal microhemorrhages (52.1%) and areas of discrete devascularization (50%) were the most prevalent microvascular findings. Capillary patterns were significantly associated with disease severity (p < 0.001).

Dermatoscopic assessment of nail fold capillaries may provide a valuable, noninvasive biomarker of disease activity in autoimmune connective tissue diseases. This study provides valuable data on skin of color, which remains underrepresented in dermatological research.