Cutaneous Profile and Nail Fold Dermoscopy in Patients with Scleroderma

Description

Abstract (English)

Abstract 
Introduction: Scleroderma is a chronic autoimmune connective tissue disorder characterized by skin thickening, 
vascular abnormalities, and multiorgan involvement. Cutaneous manifestations often provide early diagnostic 
clues, and nail fold capillaroscopy is an important non-invasive tool to assess microvascular changes and disease 
activity. 
Methods: This cross-sectional observational study was conducted over a period of one year at the Calcutta School 
of Tropical Medicine. A total of 80 patients diagnosed with systemic sclerosis (SSc) were enrolled. Data were 
collected on demographic variables including age and gender, disease-related factors such as disease duration and 
SSc subtype, as well as clinical characteristics including cutaneous features. Detailed dermoscopy and nailfold 
examinations were performed, and capillaroscopy patterns were documented. All variables were systematically 
recorded to assess their association with disease manifestations and nailfold capillaroscopic findings. 
Results: In this study of 80 systemic sclerosis patients (mean age 42.6 ± 11.3 years; 65% female), 62.5% had 
limited cutaneous SSc and 37.5% had diffuse cutaneous SSc. All patients exhibited skin thickening, with 
Raynaud’s phenomenon (87.5%) and telangiectasia (60%) as common manifestations, while digital ulcers were 
the least frequent (27.5%). Nailfold capillaroscopy patterns differed by subtype: limited SSc predominantly 
showed active patterns (40%), whereas diffuse SSc frequently exhibited late patterns (40%), with a statistically 
significant difference in the late pattern between subtypes (p = 0.002). Capillary density <7/mm correlated 
negatively with disease duration (r = -0.42, p = 0.001), and giant capillaries correlated positively (r = 0.36, p = 
0.005). Microhemorrhages showed no significant correlation with disease duration. The presence of digital ulcers 
was strongly associated with capillaroscopic patterns, particularly the late pattern (p < 0.001). 
Conclusion: Cutaneous manifestations in scleroderma are diverse and provide important diagnostic and 
prognostic information. Nail fold dermoscopy is a valuable, non-invasive tool for detecting microvascular changes 
and assessing disease severity, particularly in differentiating diffuse from limited scleroderma and monitoring 
disease progression. Early recognition of dermoscopic abnormalities can aid in timely management and potentially 
improve outcomes.