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Histopathological and capillaroscopical features of the cuticles and bleeding clots in ring or middle fingers of
1Department of Dermatology, Gifu University, School of Medicine, Japan.
Insights
Systemic scleroderma (SSc) patients show distinct nail cuticle abnormalities, including a unique three-layer pattern with eosinophilic deposits. These findings correlate with other SSc nail changes and may be rapidly transported.
Area of Science:
- Dermatology
- Rheumatology
- Histopathology
Background:
- Systemic scleroderma (SSc) is a connective tissue disease with various clinical manifestations.
- Nail cuticle changes can be indicative of underlying systemic conditions.
Purpose of the Study:
- To investigate and compare histopathological features of nail cuticles in patients with systemic scleroderma (SSc), systemic lupus erythematosus (SLE), dermatomyositis (DM), and healthy controls (HC).
- To identify specific nail cuticle abnormalities associated with SSc.
Main Methods:
- Histopathological examination of nail cuticles from ring or middle fingers of 63 SSc patients, 14 SLE patients, 9 DM patients, and 10 HC.
- Analysis of cuticle layers (upper, middle, lower), presence of eosinophilic deposits (ED), and bleeding clots (BC).
Main Results:
- SSc patients (96.8%) exhibited a typical three-layer nail pattern with eosinophilic deposits (ED) in the middle layer, unlike SLE (64.3%), DM (33.3%), and HC (0%).
- Significant correlations were found in SSc between ED, BC, and cuticle elongation.
- Capillaroscopy showed rapid transport of ED-associated bleeding clots within 1-2 weeks in SSc patients.
Conclusions:
- The distinct three-layer nail cuticle pattern with eosinophilic deposits is highly characteristic of systemic scleroderma.
- These histopathological findings in SSc cuticles correlate with clinical nail changes and may have diagnostic implications.
Abstract:
Sixty-three patients with systemic scleroderma (SSc) (Barnett I, 41; Barnett II, 17; Barnett III, 5), 14 with systemic lupus erythematosus (SLE), 9 with dermatomyositis (DM) and 10 healthy controls (HC) were subjected to histopathological examinations of the cuticles of ring or middle fingers. The sex ratios (male/female) in the patients with SSc, SLE, DM and HC were 7:56, 5:9, 5:4 and 5:5, and the ages were 22-74, 19-78, 45-70 and 13-78 years old, respectively. Biopsy samples were taken from the central portion of the cuticles, which showed the most severe change of elongation with or without bleeding clots of cuticle-proximal nailfolds (BC). Histopathologically, 61 (96.8%) cuticles of SSc patients consisted of the upper (U), middle (M) and lower (L) layers, which represent obliquely stacked, parabolic, and parallel stacked layers, respectively. The middle parabolic layer appeared to discharge homogenous eosinophilic globular deposits (ED). On the other hand, this typical three-layer-nail pattern was seen only in 9 (64.3%) of SLE, 3 (33.3%) of DM and none of HC, in total 12 (36.4%) of the non-SSc group, which included SLE, DM and HC. In SSc, there were statistical correlations (R2) between ED and BC, ED and cuticle-elongation, cuticle-layer and cuticle-elongation, ED and cuticle-layer, BC and cuticle-elongation. Capillaroscopically, bleeding clots located in the middle layer with ED of the cuticles in eight patients with SSc were transported rapidly within 1-2 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)