Nailfold capillaroscopy by dermatoscope in systemic sclerosis: a systematic review and meta-analysis
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Published on: February 28, 2025
Mislav Radić1, Hana Đogaš2, Genessis Maldonado3
1Department of Internal Medicine, Division of Rheumatology, Allergology, and Clinical Immunology, University Hospital of Split, Croatia; and Internal Medicine Department, University of Split School of Medicine, Split, Croatia. mislavradic@gmail.com.
Objectives:
Nailfold capillaroscopy is pivotal for assessing microvascular abnormalities in systemic sclerosis (SSc), with nailfold videocapillaroscopy (NVC) as the gold standard. However, NVC availability and practicality are limited in routine clinical settings, prompting interest in dermatoscope-based nailfold capillaroscopy (DNC) as an accessible alternative. This review evaluates the diagnostic value of DNC for identifying the scleroderma pattern compared to standard highmagnification techniques.
Methods:
.Systematic literature search was conducted in PubMed, Scopus and Web of Science per PRISMA-DTA guidelines. Eligible studies assessed sensitivity and specificity of DNC versus NVC or stereomicroscopy in adults. Univariate and bivariate random-effects meta-analysis pooled sensitivity, specificity, diagnostic odds ratio, and area under the Summary Receiver Operating Characteristic (SROC) curve (AUC).
Results:
Three studies, including 340 participants, met inclusion criteria. Pooled analysis demonstrated sensitivity of 56% (95% CI: 39-80%) and specificity of 95% (95% CI: 91-100%) for DNC in detecting scleroderma capillary patterns. Pooled diagnostic odds ratio was 31.83 (95% CI: 16.85-60.15), with an AUC of 0.895 indicating high diagnostic performance.
Conclusions:
Limited data demonstrate DNC offers high specificity but moderate sensitivity for identifying scleroderma patterns in SSc, making it a valuable initial screening tool for resource-limited settings in patients with Raynaud's phenomenon. While DNC cannot replace NVC for detailed microvascular assessment, its ease of use, portability, and diagnostic performance support implementation for mainly triage of capillary abnormalities in SSc and connective tissue diseases in routine clinical practice.
