Nailfold Capillaroscopic (NFC) Changes in Vasculitis and Their Correlation with Systemic Involvement: A Cross-Sectional Study.

Background: Cutaneous vasculitis involves active inflammation of blood vessels of all caliber, leading to widespread systemic involvement and morbidity. The data regarding the utility of nailfold capillaroscopy (NFC) in cutaneous vasculitis is sparse. Since NFC offers direct visualization of the affected system, the microvasculature, its role appears promising and can serve as a valuable diagnostic adjunct.

Objective: We conducted this study to evaluate various NFC changes in patients with vasculitis and correlate them with systemic involvement.

Patients and methods: A cross-sectional study involving 22 patients with cutaneous vasculitis and 15 controls was conducted to assess NFC changes using a handheld dermatoscope over a period of one year.

Results: NFC score, capillary dropouts, avascular areas, and receding capillaries were statistically significant NFC findings among cases ( P < 0.05). NFC findings, including dilated capillaries (66.7% vs. 50%), avascular areas (75% vs. 40%), and receding capillaries (66.7% vs. 50%), were more commonly observed in patients with renal involvement compared to those without. NFC score (77% vs. 61%), dilated capillaries (77.8% vs. 46.1%), tortuous capillaries (55.6% vs. 30.7%), receding capillaries (66.7% vs. 53.8%), and capillary dropouts (66.7% vs. 53.8%) were more frequently observed in patients with ulcerative skin lesions. Patients with comorbidities exhibited NFC score (80% vs. 58.3%), crisscross capillaries (30% vs. 16.7%), receding capillaries (80% vs. 41.7%), and avascular areas (70% vs. 58.3%) more commonly.

Limitations: A small sample size and only qualitative parameters could be assessed due to the lack of a video dermoscope. The study design was not intended for follow up, and a comparison of NFC changes during the active and non-active phases could not be done.

Conclusion: We conclude that capillary disorganization, capillary dropouts, receding capillaries, and avascular areas were significant findings among patients with vasculitis. Also, NFC changes were more common in patients with systemic involvement, ulcerative lesions, and in patients with underlying comorbidities.