[Raynaud's phenomenon : Practical management for dermatologists]

Altered ocular microvasculature in patients with systemic sclerosis and very early disease of systemic sclerosis using optical coherence tomography angiography

The vascular hypothesis of systemic sclerosis (SSc) would predict microvascular alterations should also affect anatomical regions like ocular microvasculature. The objective of this study was to evaluate retinal and choriocapillary vessel density (VD) in patients with definite SSc and very early disease of systemic sclerosis (VEDOSS) using optical coherence tomography angiography (OCTA). 22 eyes of 22 patients and 22 eyes of 22 healthy subjects were included in this study. Patients were classified into patients with definite SSc and patients with VEDOSS. VD data of the superficial OCT angiogram (OCTA-SCP), deep OCT angiogram (OCTA-DCP) and choriocapillaris (OCTA-CC) were analysed. VD in the OCTA-SCP and OCTA-CC was lower in patients with SSc (p < 0.05). In VEDOSS patients, VD in the OCTA-CC was still reduced compared to controls (p < 0.05). Correlation analysis revealed a positive correlation between nailfold capillaroscopy and VD of OCTA-CC (Spearman correlation coefficient (rSp) 0.456, p < 0.05) and a negative correlation between skin score and VD of OCTA-SCP (p < 0.05). Ocular perfusion seems to be impaired in patients with SSc and even VEDOSS. VD correlated with disease severity. OCTA could be a new useful diagnostic and predictive parameter for monitoring patients with different stages of the disease.

[Antinuclear antibodies : Practical diagnostic recommendations for dermatologists]

Antinuclear antibodies (ANA) are a common diagnostic finding in patients with systemic autoimmune diseases. In patients with typical clinical symptoms, the determination of ANA is of both diagnostic and prognostic importance. However, if ANA were determined due to unspecific symptoms, the interpretation of ANA findings can be problematic. In these cases, misjudgements with severe consequences for the patients are possible. Many systemic autoimmune diseases have prominent early skin involvement and the dermatologist can be the first physician that such a patient sees. Therefore, knowledge of ANA diagnostics is important for dermatologists. Basic principles of autoantibody diagnostics, guidance for the interpretation of laboratory results and new developments are discussed in this overview.

[Autoinflammatory skin diseases : Diagnosis and therapy]

Autoinflammatory syndromes are characterized by an exaggerated activation of the innate immune system and frequently present with skin symptoms. In contrast to autoimmune disorders no specific autoantibodies or autoreactive immune cells are detected. Thus, the diagnosis is usually difficult and can only be made by a careful interpretation of anamnestic, clinical and laboratory parameters. In some hereditary autoimmune syndromes specific genetic mutations are described and can be helpful for the diagnosis. For treatment of these disorders both classic immunomodulatory drugs and specific cytokine inhibitors are used, mainly directed against interleukin‑1. Long-term therapy is generally required.