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Ghannem A, Zaouak A, Aydi Z, Somai M, Hammami H, Boussema F, Fenniche S. Nail involvement in connective tissue diseases: an epidemiological, clinical, and dermoscopic study. Int J Dermatol 2024. [PMID: 38426318 DOI: 10.1111/ijd.17113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND The assessment of nail changes in connective tissue diseases (CTD) has been rarely explored in previous studies. The use of dermoscopy to study vascular changes in nailfolds is an interesting diagnostic technique. The aim of the study was to describe the epidemiological, clinical, and dermoscopic features of nail lesions in CTD. METHODS A prospective study was performed at the Dermatology Department of Habib Thameur Hospital (Tunis, Tunisia) in collaboration with the Internal Medicine Department over a period of 15 months, from July 2020 to September 2021, including patients diagnosed with systemic sclerosis (SS), systemic lupus erythematosus (SLE) and dermatomyositis (DM). RESULTS Our study included 48 patients. Nail involvement was found in 44 cases. Dermoscopic nailfold abnormalities were identified in 37 cases. The most common clinical features were ragged cuticle, nailfold erythema, and onycholysis. Additionally, splinter hemorrhage, longitudinal ridging, lunula abnormalities, melanonychia, trachyonychia, leukonychia, increase in transverse curvature, parrot beak nail, half and half nails, and onychorrhexis were described. Nailfold dermoscopy showed a normal pattern in 10 cases, a nonspecific pattern in nine cases (SLE), and a scleroderma pattern in 29 cases (SS and DM). The scleroderma pattern was further categorized into an early pattern (6), an active pattern (14), and a late pattern (9). Normal pattern was observed solely in patients in remission. The late scleroderma pattern was associated with disease duration and systemic involvement. In SLE, disease activity correlated with onycholysis, nailfold erythema, and pathologic pattern in dermoscopy. However, patients with DM displayed a positive correlation between pulmonary involvement and scleroderma pattern. CONCLUSION Nail involvement in CTD includes a diverse range of abnormalities. Despite being nonspecific, it can provide crucial clues for establishing a diagnosis. Nailfold dermoscopy serves as a mirror for microangiopathy, enabling the detection of changes at an initial stage, and thus, it becomes a diagnostic and prognostic tool.
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Affiliation(s)
- Azza Ghannem
- Department of Dermatology, Habib Thameur Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Anissa Zaouak
- Department of Dermatology, Habib Thameur Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Zohra Aydi
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
- Department of Internal Medicine, Habib Thameur Hospital, Tunis, Tunisia
| | - Mehdi Somai
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
- Department of Internal Medicine, Habib Thameur Hospital, Tunis, Tunisia
| | - Houda Hammami
- Department of Dermatology, Habib Thameur Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Fatma Boussema
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
- Department of Internal Medicine, Habib Thameur Hospital, Tunis, Tunisia
| | - Samy Fenniche
- Department of Dermatology, Habib Thameur Hospital, Tunis, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
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Onder ENA, Gokyayla E, Ermertcan AT, Ertan P. The nailfold dermoscopy findings of patients with atypical haemolytic uremic syndrome. Microvasc Res 2023; 148:104548. [PMID: 37225057 DOI: 10.1016/j.mvr.2023.104548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/23/2023] [Accepted: 05/11/2023] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Hemolytic uremic syndrome (HUS) is a severe disease characterized by microangiopathic anemia, thrombocytopenia, and acute renal failure. OBJECTIVES Atypical HUS (aHUS) that results due to genetic disorders of the alternative complement pathway results in inflammation, endothelial damage, and kidney injury. Therefore, simple and non-invasive tests are needed to evaluate the activity of the disease by assessing the microvascular structure in aHUS. METHODS A dermoscope (×10) is an inexpensive and easily portable device used to visualize nailfold capillaries and has high clinical performance and interobserver reliability. In this study, the nailfold capillaries of patients with aHUS who were in remission under eculizumab treatment were examined, and the findings were compared to those of a healthy control group to evaluate disease characteristics. RESULTS All children with aHUS had decreased capillary densities even if they were in remission. This may be indicative of ongoing inflammation and microvascular damage in aHUS. CONCLUSION A dermoscopy can be used as a screening tool for disease activity in patients with aHUS.
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Affiliation(s)
- Esra Nagehan Akyol Onder
- Manisa Celal Bayar University, School of Medicine, Department of Paediatric Nephrology, Manisa TR-45010, Turkey.
| | - Ece Gokyayla
- Manisa Celal Bayar University, Faculty of Medicine, Department of Dermatology, Manisa TR-45010, Turkey
| | - Aylin Turel Ermertcan
- Manisa Celal Bayar University, Faculty of Medicine, Department of Dermatology, Manisa TR-45010, Turkey
| | - Pelin Ertan
- Manisa Celal Bayar University, School of Medicine, Department of Paediatric Nephrology, Manisa TR-45010, Turkey
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3
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Ashida M, Morimoto S, Yozaki M, Ehara D, Koike Y, Murota H. Evaluation of sweating responses in patients with systemic connective tissue disorders using the quantitative sudomotor axon reflex test. JOURNAL OF CUTANEOUS IMMUNOLOGY AND ALLERGY 2022. [DOI: 10.1002/cia2.12269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Miwa Ashida
- Department of Dermatology Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Shimpei Morimoto
- Department of Immunology and Rheumatology Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
- Innovation Platform & Office for Precision Medicine Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
- Clinical Research Center Nagasaki University Hospital Nagasaki Japan
| | - Mariko Yozaki
- Department of Dermatology Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Daisuke Ehara
- Department of Dermatology Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Yuta Koike
- Department of Dermatology Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
- Leading medical research core unit, life‐science innovation, Nagasaki university graduate school of biomedical sciences Nagasaki Japan
| | - Hiroyuki Murota
- Department of Dermatology Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
- Leading medical research core unit, life‐science innovation, Nagasaki university graduate school of biomedical sciences Nagasaki Japan
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Ortner VK, Mandel VD, Bertugno S, Philipsen PA, Haedersdal M. Imaging of the Nail Unit in Psoriatic Patients - a Systematic Scoping Review of Techniques and Terminology. Exp Dermatol 2022; 31:828-840. [PMID: 35353919 PMCID: PMC9323418 DOI: 10.1111/exd.14572] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 03/14/2022] [Accepted: 03/26/2022] [Indexed: 11/28/2022]
Abstract
Background The growing interest in the visualization of psoriatic nail unit changes has led to the discovery of an abundance of image characteristics across various modalities. Objective To identify techniques for non‐invasive imaging of nail unit structures in psoriatic patients and review extracted image features to unify the diverse terminology. Methods For this systematic scoping review, we included studies available on PubMed and Embase, independently extracted image characteristics, and semantically grouped the identified features to suggest a preferred terminology for each technique. Results After screening 753 studies, 67 articles on the visualization of clinical and subclinical psoriatic changes in the nail plate, matrix, bed, folds and hyponychium were included. We identified 4 optical and 3 radiological imaging techniques for the assessment of surface (dermoscopy [n = 16], capillaroscopy [n = 12]), sub‐surface (ultrasound imaging [n = 36], optical coherence tomography [n = 4], fluorescence optical imaging [n = 3]), and deep‐seated psoriatic changes (magnetic resonance imaging [n = 2], positron emission tomography‐computed tomography [n = 1]). By condensing 244 image feature descriptions into a glossary of 82 terms, overall redundancy was cut by 66.4% (37.5%–77.1%). More than 75% of these image features provide additional disease‐relevant information that is not captured using conventional clinical assessment scales. Conclusions This review has identified, unified, and contextualized image features and related terminology for non‐invasive imaging of the nail unit in patients with psoriatic conditions. The suggested glossary could facilitate the integrative use of non‐invasive imaging techniques for the detailed examination of psoriatic nail unit structures in research and clinical practice.
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Affiliation(s)
- V K Ortner
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiskberg, Denmark
| | - V D Mandel
- Dermatology Unit, Surgical, Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy.,Porphyria and Rare Diseases Unit, San Gallicano Dermatological Institute - IRCCS, Rome, Italy
| | - S Bertugno
- Radiology Unit, Bernardino Ramazzini Hospital, Carpi, Italy
| | - P A Philipsen
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiskberg, Denmark
| | - M Haedersdal
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiskberg, Denmark
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Żychowska M, Łudzik J, Witkowski A, Lee C, Reich A. Dermoscopy of Gottron's papules and other inflammatory dermatoses involving the dorsa of the hands. J Eur Acad Dermatol Venereol 2022; 36:1080-1087. [PMID: 35274387 DOI: 10.1111/jdv.18052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/15/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Several inflammatory dermatoses, including dermatomyositis (DM), may present as erythematous papules or plaques on the dorsal aspects of the hands over the joints. Limited skin involvement in these entities may pose a diagnostic challenge. (Video)dermoscopy is being utilized more frequently to aid in differential diagnosis of inflammatory skin conditions. OBJECTIVE To describe the dermoscopic findings in Gottron's papules and compare with dermoscopic features of other dermatoses involving the dorsal aspects of the hands. METHODS Videodermoscopic images from patients presenting with erythematous papules or plaques on the dorsal surface of the hands were retrospectively analyzed for the presence of standardized dermoscopic parameters. RESULTS Dermoscopic images from patients with DM (n=12), psoriasis (n=19), chronic dermatitis (n=16), mycosis fungoides (n=7), lichen planus (n=5) and pityriasis rubra pilaris (n=3) were included. Gottron's papules were characterized by pleomorphic vessels (dotted vessels accompanied by thick or thin linear vessels with branches or linear curved vessels) in 66.7% of cases, arranged in unspecified pattern (91.7%), and accompanied by white or pink structureless areas (75.0%). Psoriatic plaques were characterized by dotted vessels arranged in a uniform pattern (94.7%). Vessels arranged in a ring pattern were nearly exclusively observed in psoriasis, while yellow structureless areas and erosions were more frequently present in chronic dermatitis. White lines, corresponding to Wickham striae, were specific for lichen planus. CONCLUSIONS Videodermoscopy might be of value in differentiating Gottron's papules from other dermatoses involving dorsa of the hands.
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Affiliation(s)
- M Żychowska
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszów University, Rzeszów, Poland
| | - J Łudzik
- Department of Telemedicine and Bioinformatics, Jagiellonian University Medical College, Krakow, Poland.,Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
| | - A Witkowski
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
| | - C Lee
- Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA
| | - A Reich
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszów University, Rzeszów, Poland
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Żychowska M, Reich A. Dermoscopy and Trichoscopy in Dermatomyositis-A Cross-Sectional Study. J Clin Med 2022; 11:jcm11020375. [PMID: 35054069 PMCID: PMC8778875 DOI: 10.3390/jcm11020375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND (Video)dermoscopy is a non-invasive diagnostic technique that has a well-established role in dermatooncology. In recent years, this method has also been increasingly used in the assessment of inflammatory dermatoses. So far, little is known about the (video)dermoscopic features of dermatomyositis (DM). METHODS Consecutive patients with DM were included in the study and videodermoscopic assessments of the nailfolds, scalp, and active skin lesions were performed. RESULTS Fifteen patients with DM (10 women and 5 men) were included. Capillaroscopy showed elongated capillaries (90.9%), avascular areas (81.8%), disorganized vessel architecture (81.8%), tortuous capillaries (72.7%), dilated capillaries (72.7%), and hemorrhages (72.7%). The trichoscopic findings included linear branched vessels (80.0%), linear vessels (60.0%), linear curved vessels (53.3%), perifollicular pigmentation (40.0%), perifollicular erythema (33.3%), scaling (20.0%), white (20.0%) or yellow (20%) interfollicular scales, and white (20.0%) or pinkish (13.3%) structureless areas. Polymorphic vessels of an unspecific distribution and white or pink structureless areas were frequently observed under dermoscopy in cutaneous manifestations of DM, including Gottron's papules and Gottron's sign. CONCLUSIONS Dermoscopy of the nailfolds (capillaroscopy), scalp (tricoscopy), and active cutaneous lesions may be of value in the preliminary diagnosis of DM.
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Ashida M, Koga T, Morimoto S, Yozaki M, Ehara D, Koike Y, Murota H. Evaluation of sweating responses in patients with collagen disease using the quantitative sudomotor axon reflex test (QSART): a study protocol for an investigator-initiated, prospective, observational clinical study. BMJ Open 2021; 11:e050690. [PMID: 34706954 PMCID: PMC8552179 DOI: 10.1136/bmjopen-2021-050690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Sweat secretion is controlled by the sympathetic nervous system and is less active during winter than in the summer. Raynaud's phenomenon is affected by an excessive strain of the sympathetic nerves after exposure to a cold environment, thus reducing the quality of life of patients with collagen disease. Herein, we focus on the eccrine sweat glands that receive both adrenergic and cholinergic innervation. Our hypothesis is that excessive activation of sympathetic nerve in Raynaud's phenomenon can affect sweating, especially in winter. This study is designed to evaluate the neuroactive sweating responses in patients with collagen disease and to assess its association with skin findings in peripheral circulatory disorders. METHODS AND ANALYSIS The study will be conducted at a single centre in Japan. Patients with systemic sclerosis, Sjogren's syndrome, systemic lupus erythematosus, mixed connective tissue disease, and dermatomyositis will be assessed using the quantitative sudomotor axon reflex test. The primary outcomes will be sweat volume and reaction time due to axon reflex and the Raynaud's condition score. The secondary outcomes will include patient background, skin symptoms (digital ulcers, pernio-like eruptions, subcutaneous calcifications, telangiectasia, nailfold capillary dilatation/bleeding and degree of skin sclerosis) and skin surface temperature. Evaluation will be done two times, during the summer and winter, allowing for the assessment of seasonal differences in sweating responses. ETHICS AND DISSEMINATION Ethical approval of this study was certified by the clinical research review board of Nagasaki University Hospital (Reference number: CRB19-001). We will disseminate the findings of this study through peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER jRCTs072190009; pre-results.
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Affiliation(s)
- Miwa Ashida
- Department of Dermatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Nagasaki, Japan
| | - Tomohiro Koga
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Nagasaki, Japan
- Center for Bioinformatics and Molecular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Nagasaki, Japan
| | - Shimpei Morimoto
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Nagasaki, Japan
- Innovation Platform & Office for Precision Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Nagasaki, Japan
- Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Mariko Yozaki
- Department of Dermatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Nagasaki, Japan
| | - Daisuke Ehara
- Department of Dermatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Nagasaki, Japan
| | - Yuta Koike
- Department of Dermatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Nagasaki, Japan
| | - H Murota
- Department of Dermatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Nagasaki, Japan
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Demirbaş A, Elmas ÖF, Demirbaş GU, Atasoy M, Türsen Ü, Lotti T. Potential Utility of Oral Mucosal Capillaroscopy as an Indicator of Microvascular Damage in Behçet Disease: A Preliminary Study. Dermatol Pract Concept 2021; 11:e2021116. [PMID: 34631265 DOI: 10.5826/dpc.1104a116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2020] [Indexed: 10/31/2022] Open
Abstract
Introduction Behçet disease (BD) is an auto-inflammatory condition characterized by multisystemic vasculitis. Oral mucosal capillaroscopy is an easy-to-use, repeatable, non-invasive method for evaluating mucosal microvasculature, contributing to the differential diagnosis and prognosis of various acute and chronic inflammatory diseases. Objectives This study aims to characterize and describe the oral labial mucosal capillary findings in patients with BD using handheld dermatoscopy and to investigate the relationship between the capillary findings and the severity of the disease. Methods This cross-sectional study included patients with BD and healthy subjects. Capillaroscopic examination of the oral labial mucosa in each subject was performed by a handheld dermatoscope using polarized light. The clinical severity of BD was evaluated using Krause's Clinical Severity Scoring for BD. Results Sixty patients with BD and 60 healthy subjects were enrolled in the study. The frequencies of irregular capillaries, microhemorrhages, glomerular vessels, megacapillaries, and tortuous vessels were statistically significantly higher in the patient group when compared to the healthy individuals. In addition, a correlation was detected between the oral mucosal capillaroscopic findings and disease duration, severity, and vascular complications. Conclusions Our study is the first to explore the potential role of oral mucosal capillaroscopic examination in patients with BD. Data obtained from this study indicated that oral mucosal capillaroscopy may be a useful tool to demonstrate microvascular damage in patients with BD.
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Affiliation(s)
| | - Ömer Faruk Elmas
- Department of Dermatology, Kırıkkale University Kırıkkale, Turkey
| | - Gözde Ulutaş Demirbaş
- Department of Dermatology, Evliya Çelebi Training and Research Hospital, Kütahya, Turkey
| | - Mustafa Atasoy
- Health Science University, Kayseri City Hospital, Department of Dermatology, Kayseri, Turkey
| | - Ümit Türsen
- Mersin University, Department of Dermatology, Mersin, Turkey
| | - Torello Lotti
- Department of Dermatology, Guglielmo Marconi University, Rome, Italy
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Chanprapaph K, Fakprapai W, Limtong P, Suchonwanit P. Nailfold Capillaroscopy With USB Digital Microscopy in Connective Tissue Diseases: A Comparative Study of 245 Patients and Healthy Controls. Front Med (Lausanne) 2021; 8:683900. [PMID: 34422857 PMCID: PMC8377356 DOI: 10.3389/fmed.2021.683900] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/25/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Nailfold capillaroscopy (NFC) is a valuable tool to detect microcirculation abnormalities in connective tissue diseases (CTDs). However, whether the universal serial bus (USB) digital microscopy used as onychoscopy is as effective as the videocapillaroscopy in determining the diagnostic and prognostic values of CTDs remains to be determined. Objective: This study aims to investigate NFC features of systemic lupus erythematosus (SLE), dermatomyositis (DM), and systemic sclerosis (SSc) patients and compare with normal controls as well as examine which feature could differentiate among CTDs. Furthermore, we aim to explore different capillaroscopic abnormalities and their association with disease activity. Methods: Nailfold images were taken from patients and healthy controls using a USB digital microscopy. Patterns on the capillary morphology, diameter, architecture, and density were recorded and compared. We further determined the NFC findings in SLE, DM, and SSc and corresponded to their respective disease activity scoring system. Results: A total of 245 participants, consisting of 54 SLE, 32 DM, and 51 SSc patients, as well as 108 controls, were enrolled. All capillaroscopic features, except for tortuous capillaries, were significantly more common in CTDs than healthy control (all p < 0.05). A multinomial logistic regression analysis revealed that bushy capillaries had significantly higher odds for both SLE and DM than SSc (OR: 4.10, 95% confidence interval (CI): 1.71-9.81, p = 0.002 and OR: 7.82, 95% CI, 2.86-21.38, p < 0.001, respectively). Elongated capillaries demonstrated significant odds for SLE compared with SSc (OR: 3.35, 95% CI: 1.005-11.20, p = 0.049), while prominent subpapillary plexus showed greater odds for SLE compared with both DM and SSc (OR: 2.75, 95% CI: 1.07-7.02, p = 0.03 and OR: 5.78, 95% CI: 2.29-14.58, p < 0.001, respectively). The presence of hemorrhage, enlarged capillaries, and the low-density index had significantly higher odds in favor of SSc than SLE. Bushy capillaries were the only pattern with a strong association for DM over SSc. The presence of enlarged capillaries indicated higher SLE severity, but no specific finding was related to DM or SSc skin scores. Conclusions: Nailfold capillaroscopic examination using a digital microscope is a valuable method for the diagnosis of SLE, DM, and SSc. Several morphologic patterns can help differentiate among CTDs; however, the prognostic significance of this method requires further investigations.
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Affiliation(s)
- Kumutnart Chanprapaph
- Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wuttidej Fakprapai
- Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Preeyachat Limtong
- Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Poonkiat Suchonwanit
- Division of Dermatology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Papadopoulou C, Hong Y, Krol P, Al Obaidi M, Pilkington C, Wedderburn LR, Brogan PA, Eleftheriou D. The Vasculopathy of Juvenile Dermatomyositis: Endothelial Injury, Hypercoagulability, and Increased Arterial Stiffness. Arthritis Rheumatol 2021; 73:1253-1266. [PMID: 33393715 DOI: 10.1002/art.41639] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 12/31/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Vasculopathy is considered central to the pathogenesis of juvenile dermatomyositis (DM) and is associated with severe extramuscular manifestations. We undertook this study to investigate the hypothesis that the vasculopathy of juvenile DM can be noninvasively tracked by examining biomarkers of endothelial injury, subclinical inflammation, hypercoagulability, and vascular arterial stiffness. METHODS The study population was a UK cohort of children with juvenile DM. Circulating endothelial cells (CECs) and microparticles (MPs) were identified using immunomagnetic bead extraction and flow cytometry, respectively. Plasma thrombin generation was determined using a fluorogenic assay. Cytokine and chemokine levels were measured by electrochemiluminescence. Arterial stiffness was assessed using pulse wave velocity (PWV). Results were expressed as the median and interquartile range (IQR), and statistical significance was assessed using nonparametric analyses. RESULTS Ninety patients with juvenile DM and 79 healthy control subjects were included. The median age of the patients was 10.21 years (IQR 6.68-13.40), and the median disease duration was 1.63 years (IQR 0.28-4.66). CEC counts were higher in all patients with juvenile DM compared to controls (median 96 cells/ml [IQR (40-192] and 12 cells/ml [IQR 8-24], respectively; P < 0.0001). Circulating MP numbers were also significantly higher in patients with active juvenile DM compared to controls (median 204.7 × 103 /ml [IQR 87.9-412.6] and 44.3 × 103 /ml [IQR 15.0-249.1], respectively; P < 0.0001). MPs were predominantly of platelet and endothelial origin. Enhanced plasma thrombin generation was demonstrated in patients with active juvenile DM compared to those with inactive disease (P = 0.0003) and controls (P < 0.0001). Carotid-radial PWV adjusted for age was increased in patients with juvenile DM compared to controls (P = 0.003). CONCLUSION We observed increased endothelial injury and increased levels of proinflammatory cytokines in patients with active juvenile DM. MP profiles reflected distinct disease activity status in juvenile DM and are markers of vascular pathology, platelet activation, and thrombotic propensity. Ongoing long-term vascular injury may result in increased arterial stiffness in patients with juvenile DM.
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Affiliation(s)
- Charalampia Papadopoulou
- University College London Great Ormond Street Institute of Child Health and Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Ying Hong
- University College London Great Ormond Street Institute of Child Health and Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Petra Krol
- University College London Great Ormond Street Institute of Child Health and Great Ormond Street Hospital NHS Foundation Trust, London, UK, and Skåne University Hospital, Lund, Sweden
| | - Muthana Al Obaidi
- University College London Great Ormond Street Institute of Child Health and Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Clarissa Pilkington
- University College London Great Ormond Street Institute of Child Health and Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Lucy R Wedderburn
- University College London Great Ormond Street Institute of Child Health, Great Ormond Street Hospital NHS Foundation Trust, NIHR Great Ormond Street Hospital Biomedical Research Centre, and Centre for Adolescent Rheumatology Versus Arthritis, London, UK
| | - Paul A Brogan
- University College London Great Ormond Street Institute of Child Health and Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Despina Eleftheriou
- University College London Great Ormond Street Institute of Child Health, Great Ormond Street Hospital NHS Foundation Trust, and Centre for Adolescent Rheumatology Versus Arthritis, London, UK
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Arslan NG, Pancar GS. Nailfold capillaroscopic changes of sleep apnea patients. Microvasc Res 2021; 137:104177. [PMID: 33984340 DOI: 10.1016/j.mvr.2021.104177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/01/2021] [Accepted: 05/06/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Obstructive Sleep Apnea Syndrome (OSAS) have frequent association with comorbidities and this makes it an independent risk factor for cardiovascular disease. Not only endothelial dysfunction, but also arterial stiffening, increased inflammatory mediators, oxidative stress after hypoxemia that develops due to OSAS, cause vascular pathologies in all diameters of vessels. Nail bed capillaroscopy is a simple, noninvasive, useful method to examine microcirculation and evaluate nail bed capillary abnormalities in diseases that cause vascular damage. The aim of this study is to examine microvascular changes in the nail bed of OSAS patients by capillaroscopy. METHODS 59 OSAS patients and 60 healthy cases (totally 119) were included. One single attended polysomnography was applied with Embla N7000 series (RemLogic Eastmed, Natus); and apnea-hypopnea index (AHI), oxygen de-saturation index >4% (ODI4%), minimum oxygen saturation (SaO2 Min.), total duration of oxygen desaturation, comorbidities, body mass index (BMI), smoking habit, sleep questionnaire applications were analyzed. Nailfold capillaroscopy was performed using a digital dermoscope (Molemax II, X30) and all images were evaluated for capillary density, capillary loop enlargement, capillary tortuosity, branching vessels, micro hemorrhages, avascular areas and splinter hemorrhages. RESULTS The prevalence rates of all capillaroscopy findings were significantly higher in the patient group (p < 0.05). There was an inverse and moderate relationship between AHI and mean saturation (p < 0.05). A statistically significant correlation was detected between the presence of hypertension (HT) and the severity of capillary tortuosity (CT) (p = 0.002), avascular area (AA) (p = 0.004), and periungual cyanosis (PUC) (p = 0.042); also between smoking habit and intensity of capillary dilatation, enlargement dilatation-enlarged giant capillaries (CELON) (p = 0.004), CT (p = 0.018) findings. Capillary distribution (CD), CELON, CT and AA findings were significantly higher in the group with low mean saturation (p < 0.05). DM was found to be significantly higher in individuals with high Epworth Sleep Scale (ESS) (p = 0.035). CONCLUSION In this study; 1) the nail bed capillaroscopy was used to examine vascular damage in OSAS, and 2) irregularities detected in the distal nail bed specific to a disease have been mentioned for the first time. It has been shown that endothelial damage is particularly related to the severity of hypoxia. HT and smoking history causes endothelial damage independent of the severity of the disease and hypoxia. Also, ESS may be more determinant in the screening of sleep disorders in diabetic patients.
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Affiliation(s)
- Nevra Gullu Arslan
- Samsun Educational and Research Hospital, Department of Pulmonology, TR-55000 Samsun, Turkey.
| | - Gunseli Sefika Pancar
- Samsun Education and Research Hospital, Department of Dermatology, TR-55000 İlkadim, Samsun, Turkey
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Starace M, Alessandrini A, Piraccini BM. Dermoscopy of the Nail Unit. Dermatol Clin 2021; 39:293-304. [PMID: 33745641 DOI: 10.1016/j.det.2020.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Nail dermoscopy (onychoscopy) is being used for a more accurate diagnosis of all nail disorders and has become a routine diagnostic instrument. In daily practice, nail signs can be magnified, and dermoscopy may confirm the clinical diagnosis and guides in management of nail diseases and treatments, permitting a better visualization of symptoms. Onychoscopy is used by the experts in almost all nail diseases. It can be performed dry or with ultrasound gel in order to make the stratum corneum translucent, depending on which part of the nail unit has to be evaluated.
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Affiliation(s)
- Michela Starace
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via Massarenti 1, Bologna 40138, Italy.
| | - Aurora Alessandrini
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via Massarenti 1, Bologna 40138, Italy
| | - Bianca Maria Piraccini
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via Massarenti 1, Bologna 40138, Italy
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Nailfold Capillary Hemorrhages: Microvascular Risk Factors for Primary Open-Angle Glaucoma. J Ophthalmol 2020; 2020:8324319. [PMID: 32587763 PMCID: PMC7301193 DOI: 10.1155/2020/8324319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 05/12/2020] [Accepted: 05/20/2020] [Indexed: 11/18/2022] Open
Abstract
Background Primary open-angle glaucoma (POAG) is associated with systemic microvascular dysfunction including hemorrhages and other abnormalities of the nailfold capillary bed. This study aimed to verify the specificity of nailfold capillary hemorrhages and other abnormalities as risk factors for POAG. Methods Nailfold video capillaroscopy was performed using a JH-1004 capillaroscope on the fourth and fifth digits of the nondominant hand in control (n = 277), POAG (n = 206), OHT (n = 57), and SG (n = 29) subjects. The number of hemorrhages, dilated capillaries >50 µm, and avascular zones ≥200 µm were counted and adjusted to counts per 100 capillaries. Descriptive analyses as well as univariate- and multivariable-adjusted logistic regression were performed comparing all groups with controls and POAG with OHT and SG. Subanalyses were conducted in POAG patients examining the association between nailfold capillary outcomes and previous glaucoma surgery, successful IOP control, or disease severity. Results All nailfold capillary outcomes were significantly increased in POAG, no outcomes were increased in SG, and only hemorrhages were mildly increased in OHT. Hemorrhages were significantly more frequent in POAG compared with both OHT (P < 0.0001) and SG (P=0.001). There were significant trends between higher numbers of hemorrhages and POAG compared with controls, OHT, and SG, with odds ratios of 18.3 (8.5-39.4), 9.1 (1.9-13.4), and 11.8 (1.7-7.3), respectively, for the presence of two or more hemorrhages per 100 capillaries. Hemorrhages were not significantly associated with previous glaucoma surgery, successful postoperative IOP control, or disease severity in POAG. Conclusions These findings suggest that systemic microvascular dysfunction is frequent in POAG and occurs early in the disease process. The high specificity of nailfold hemorrhages makes them viable clinical risk factors for POAG.
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Retiform purpura: A diagnostic approach. J Am Acad Dermatol 2020; 82:783-796. [DOI: 10.1016/j.jaad.2019.07.112] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/15/2019] [Accepted: 07/28/2019] [Indexed: 12/28/2022]
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Pancar GS, Kaynar T. Nailfold capillaroscopic changes in patients with chronic viral hepatitis. Microvasc Res 2019; 129:103970. [PMID: 31891718 DOI: 10.1016/j.mvr.2019.103970] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 12/22/2019] [Accepted: 12/22/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND Nailfold capillaroscopy is a highly sensitive, inexpensive, simple, safe, and noninvasive technique used in the investigation of the microcirculation. However, the diseases having a vasculitic component can cause changes in the nailfold capillaries like viral hepatitis, the microvascular characteristics of the nailfold area in HBV and HCV infected individuals have not been systematically investigated. In this study, we investigated possible dermoscopic differences in the vascular appearance of the nailfold capillaries and their association with the disease's clinical status. METHOD A hundred and forty-seven patients and 147 healthy controls were enrolled in this study. The patients' group consisted of chronic viral hepatitis B (CHB: 54 cases), chronic hepatitis C (CHC: 36 cases) and carrier of hepatitis B virus infection (CRHB: 57 cases). Nailfold capillaroscopy was performed using a digital dermoscope (Molemax II, X30). All capillaroscopy images were evaluated for capillary density, capillary loop enlargement, capillary tortuosities, branching vessels, micro hemorrhages, avascular areas and splinter hemorrhages, and routine laboratory examinations of all patients were performed. RESULTS Statistical differences in all of the categories of capillary morphology were prominent between the capillary abnormalities of Hepatitis B and the control group, also the capillary abnormality was significant between hepatitis C and the control group (p < 0.01). None of the 147 healthy control had any nailfold capillary changes. There was a significant difference between the CHB-Control and CRHB-Control groups in all of the capillaroscopic changes (p < 0.01). The avascular area was also the most common finding in Hepatitis C and Hepatitis B infected individuals, and capillary dilatation (CD), capillary tortuosity (CT) and capillary enlargement (CE) were the major nailfold capillary changes in both of two diseases. CONCLUSION Nailfold capillary abnormalities are one of the extrahepatic dermatologic finding which could be a sign of the endothelial tissue damage in chronic viral hepatitis, we do not have any data about the effects of these two usual infections on the nailfold capillary morphology. This is the first study evaluating the microvasculature abnormalities of the nailfold capillaries in hepatitis B and hepatitis C infected individuals by capillaroscopic examination.
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Affiliation(s)
- G S Pancar
- Samsun Education and Research Hospital, Department of Dermatology, Samsun, Turkey.
| | - T Kaynar
- Samsun Gazi Government Hospital, Department of Infectious Diseases, Samsun, Turkey
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Edamitsu T, Uhara H, Minagawa A, Okuyama R. Multiple melanonychia striata as a sign of connective tissue disorders. J Am Acad Dermatol 2018; 79:375-377. [DOI: 10.1016/j.jaad.2018.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 01/05/2018] [Accepted: 01/09/2018] [Indexed: 10/18/2022]
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18
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Jasso-Olivares JC, Tosti A, Miteva M, Domínguez-Cherit J, Díaz-González JM. Clinical and Dermoscopic Features of the Scalp in 31 Patients with Dermatomyositis. Skin Appendage Disord 2017; 3:119-124. [PMID: 28879187 DOI: 10.1159/000464469] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 02/21/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Scalp involvement is not directly evaluated in patients with dermatomyositis (DM). Therefore, the exact frequency of scalp dermatomyositis (SDM) and its clinical and trichoscopic characteristics have been poorly described. OBJECTIVE The aim of this study was to determine the frequency and clinical and dermoscopic features of SDM in patients diagnosed with DM. METHODS We performed a descriptive prospective, cross-sectional observational study that included all patients diagnosed with DM at a Mexican academic institute over the course of a year. RESULTS Twenty-four out of 31 patients with DM had scalp involvement at clinical examination, with a prevalence of 77.4%. SDM was clinically characterized by erythema in all cases, scales in 20 (83.3%) patients, nonscarring alopecia in 21 (87.5%) patients, pruritus in 17 (70.8%) patients, and poikiloderma of the scalp in 16 (51.6%) patients. Twenty-eight patients were evaluated by trichoscopy. The most consistent finding was the presence of enlarged capillaries, found in 20 (71.4%) cases, followed by peripilar casts (57.1%) and tufting and interfollicular scales in 14 (50%) cases. Twenty-two patients also had positive nail fold capillaroscopic features similar to those observed by trichoscopy. LIMITATIONS The simple size was limited. CONCLUSIONS Scalp involvement and alopecia are common in patients with DM, and trichoscopy shows features similar to those found at capillaroscopy. Trichoscopy is a very important tool for diagnosis of scalp involvement in patients with DM.
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Affiliation(s)
- Julio C Jasso-Olivares
- Department of Dermatology and Cutaneous Surgery, National Institute of Medical Sciences and Nutrition "Salvador Zubirán", Mexico City, Mexico
| | - Antonella Tosti
- Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Mariya Miteva
- Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Judith Domínguez-Cherit
- Department of Dermatology and Cutaneous Surgery, National Institute of Medical Sciences and Nutrition "Salvador Zubirán", Mexico City, Mexico
| | - José M Díaz-González
- Department of Dermatology and Cutaneous Surgery, National Institute of Medical Sciences and Nutrition "Salvador Zubirán", Mexico City, Mexico
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Alessandrini A, Starace M, Piraccini BM. Dermoscopy in the Evaluation of Nail Disorders. Skin Appendage Disord 2017; 3:70-82. [PMID: 28560217 DOI: 10.1159/000458728] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 02/01/2017] [Indexed: 11/19/2022] Open
Abstract
Nail dermoscopy was initially used only in the assessment of nail pigmentation, but now it is widely utilized for the evaluation of many nail disorders. In daily practice, dermoscopy may confirm clinical diagnoses and guides in the management of nail diseases and treatments, permitting a better visualization of symptoms. Dry dermoscopy is required for evaluation of the nail plate surface, while gel as an interface is necessary for assessment of nail pigmentation and onycholysis, as well as for the evaluation of the distal nail margin. In this review, we describe the dermoscopic features of the most important nail disorders, looking at the different areas of the nail. Dermatoscopic changes that usually accompany specific nail diseases are also reviewed.
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Affiliation(s)
- Aurora Alessandrini
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Michela Starace
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Bianca Maria Piraccini
- Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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Errichetti E, Zabotti A, Stinco G, Quartuccio L, Sacco S, De Marchi G, Piccirillo A, De Vita S. Dermoscopy of nail fold and elbow in the differential diagnosis of early psoriatic arthritis sine psoriasis and early rheumatoid arthritis. J Dermatol 2016; 43:1217-1220. [DOI: 10.1111/1346-8138.13438] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 03/28/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Enzo Errichetti
- Department of Experimental and Clinical Medicine; Institute of Dermatology; University of Udine; Udine Italy
| | - Alen Zabotti
- Department of Medical and Biological Sciences; Rheumatology Clinic; University of Udine; Udine Italy
| | - Giuseppe Stinco
- Department of Experimental and Clinical Medicine; Institute of Dermatology; University of Udine; Udine Italy
| | - Luca Quartuccio
- Department of Medical and Biological Sciences; Rheumatology Clinic; University of Udine; Udine Italy
| | - Stefania Sacco
- Department of Medical and Biological Sciences; Rheumatology Clinic; University of Udine; Udine Italy
| | - Ginevra De Marchi
- Department of Medical and Biological Sciences; Rheumatology Clinic; University of Udine; Udine Italy
| | | | - Salvatore De Vita
- Department of Medical and Biological Sciences; Rheumatology Clinic; University of Udine; Udine Italy
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21
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Dermoscopic insight into skin microcirculation – Burn depth assessment. Burns 2015; 41:1708-1716. [DOI: 10.1016/j.burns.2015.08.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 08/21/2015] [Accepted: 08/26/2015] [Indexed: 11/24/2022]
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Fueyo-Casado A, Campos-Muñoz L, Pedraz-Muñoz J, Conde-Taboada A, López-Bran E. Nail fold dermoscopy as screening in suspected connective tissue diseases. Lupus 2015; 25:110-1. [PMID: 26385223 DOI: 10.1177/0961203315605369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 08/18/2015] [Indexed: 11/15/2022]
Affiliation(s)
- A Fueyo-Casado
- Servicio de Dermatología del Hospital Clínico San Carlos de Madrid, Universidad Complutense de Madrid, Spain
| | - L Campos-Muñoz
- Servicio de Dermatología del Hospital Clínico San Carlos de Madrid, Universidad Complutense de Madrid, Spain
| | - J Pedraz-Muñoz
- Servicio de Dermatología del Hospital Clínico San Carlos de Madrid, Universidad Complutense de Madrid, Spain
| | - A Conde-Taboada
- Servicio de Dermatología del Hospital Clínico San Carlos de Madrid, Universidad Complutense de Madrid, Spain
| | - E López-Bran
- Servicio de Dermatología del Hospital Clínico San Carlos de Madrid, Universidad Complutense de Madrid, Spain
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Abstract
Nail abnormalities can arise in conjunction with or as a result of systematic pathologies. These pathologies include single-organ diseases, multisystemic diseases, and drug-induced insults. Clinical signs associated with these conditions include dyschromias, vascular alterations, periungual tissue changes, textural dystrophies, contour alterations, and growth-rate alterations. The associated systemic pathologies may affect any part of the nail apparatus, including the nail matrix, the nail plate, the nail bed, the underlying vasculature, and the periungual tissues. The anatomical location and extent of damage determine the clinically manifested anomaly.
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Fichel F, Baudot N, Gaitz JP, Trad S, Barbe C, Francès C, Senet P. Systemic Sclerosis with Normal or Nonspecific Nailfold Capillaroscopy. Dermatology 2014; 228:360-7. [DOI: 10.1159/000360159] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 01/29/2014] [Indexed: 11/19/2022] Open
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GIAMPETRUZZI ANNAR, MONDINO CHIARA, FACCHIANO ANTONIO, BONO RICCARDO, PUDDU PIETRO, DIDONA BIAGIO, ABENI DAMIANO, CUTOLO MAURIZIO. Association of Dermoscopic Profiles of Telangiectases with Nailfold Videocapillaroscopic Patterns in Patients with Systemic Sclerosis. J Rheumatol 2013; 40:1630-2. [DOI: 10.3899/jrheum.130171] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Abstract
Nail dermoscopy is becoming more and more frequently utilized for the diagnosis of nail disorders. It can be performed with handy dermoscope or with a video dermoscope, which allows magnifications of up to 200. Nail dermoscopy requires a good knowledge of nail anatomy and physiology and the pathogenesis of nail diseases: we have to know which part of the nail we have to look at! The nail is in fact not visible as a whole at one time, but its different parts should be observed, moving the lens back and forth and transversally. All nail disorders can be observed by dermoscopy. However, except for some diseases in which the technique really adds a lot to clinical examination, in most of the cases, nail dermoscopy only permits a better visualization of symptoms already evident to the naked eye. Dermoscopic features of nail signs are always very interesting and surprising, and may help in our understanding of nails.
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Affiliation(s)
- Bianca Maria Piraccini
- Division of Dermatology, Department of Internal Medicine, Aging and Nephrological Diseases, University of Bologna, Bologna, Italy.
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Zalaudek I, Lallas A, Moscarella E, Longo C, Soyer HP, Argenziano G. The dermatologist's stethoscope-traditional and new applications of dermoscopy. Dermatol Pract Concept 2013; 3:67-71. [PMID: 23785649 PMCID: PMC3663399 DOI: 10.5826/dpc.0302a11] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 02/15/2013] [Indexed: 11/23/2022] Open
Affiliation(s)
- Iris Zalaudek
- Dermatology and Skin Cancer Unit, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Reggio Emilia, Italy ; Department of Dermatology, Medical University of Graz, Graz, Austria
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Sticherling M. Systemic sclerosis - focus on dermatological aspects. Part 2: diagnostics, therapy. J Dtsch Dermatol Ges 2012; 10:783-91. [PMID: 23107322 DOI: 10.1111/j.1610-0387.2012.07998.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Systemic sclerosis is a chronic inflammatory multiorgan disease which may involve the skin and internal organs to a varying extent. Pathogenetically the vasculature, connective tissue and the immune system are involved in a yet to be defined sequence and impact. Case history and results of physical as well as laboratory examinations will determine individually adapted further organ imaging or invasive procedures. Based on their results therapy is initiated which may include supportive measures such as physiotherapy as well as basic skin care and avoidance of any trauma. Many agents are available for the circulatory problems including Raynaud phenomenon and digital ulcers such as calcium channel blockers, ACE inhibitors and intravenous prostacyclin derivatives, as well as endothelin receptor blockers and phosphodiesterase inhibitors. Immunosuppressive and immunomodulatory agents are of varying efficacy depending on organ involvement. Though various therapeutic measures are available, beneficial effects are limited and associated with various unwanted effects. In any case, the therapy has to be individually adapted to the disease stage and course of the disease.
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Oiso N, Matsuda H, Kawada A. Various colour gradations as a dermatoscopic feature of cutaneous angiosarcoma of the scalp. Australas J Dermatol 2012; 54:36-8. [PMID: 22458422 DOI: 10.1111/j.1440-0960.2012.00885.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Naoki Oiso
- Department of Dermatology, Kinki University Faculty of Medicine, Osaka, Japan.
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