Cutaneous Profile and Nail Fold Dermoscopy in Patients with Scleroderma

e-ISSN: 0976-822X, p-ISSN:2961-6042 Available online on http://www.ijcpr.com/ International Journal of Current Pharmaceutical Review and Research 2025; 17(8); 648-652 Goswami et al. International Journal of Current Pharmaceutical Review and Research 648 Original Research Article Cutaneous Profile and Nail Fold Dermoscopy in Patients with Scleroderma Rik Goswami1, Saswati Halder2, Projna Biswas3 1Senior Resident, MBBS, MD, Department of Dermatology, Calcutta School of Tropical Medicine, Kolkata, West Bengal 700073 2Head of Department, MBBS, MD, Department of Dermatology, Calcutta School of Tropical Medicine, Kolkata, West Bengal 700073 3Assistant Professor, MBBS, MD, Department of Dermatology, Calcutta School of Tropical Medicine, Kolkata, West Bengal 700073 Received: 01-06-2025 / Revised: 16-07-2025 / Accepted: 13-08-2025 Corresponding Author: Dr. Rik Goswami Conflict of interest: Nil 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. Keywords: Scleroderma, Cutaneous Manifestations, Nail Fold Dermoscopy, Microvascular Changes, Skin Thickening, Autoimmune Connective Tissue Disease. This is an Open Access article that uses a funding model which does not charge readers or their institutions for access and distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0) and the Budapest Open Access Initiative (http://www.budapestopenaccessinitiative.org/read), which permit unrestricted use, distribution, and reproduction in any medium, provided original work is properly credited. Introduction Systemic sclerosis (SSc), also known as scleroderma, is a complex autoimmune connective tissue disorder characterized by widespread fibrosis, vascular alterations, and immune system dysregulation [1]. The disease encompasses two major subtypes: limited cutaneous systemic sclerosis (lcSSc) and diffuse cutaneous systemic sclerosis (dcSSc), each with distinct clinical presentations and prognostic implications [2]. Early detection and monitoring of disease progression are critical for effective management, and non-invasive imaging techniques have become indispensable tools in this regard [3]. Among these techniques, nailfold capillaroscopy has emerged as a pivotal method for assessing microvascular changes in SSc patients [4]. This technique involves the examination of capillaries at the nailfold using high magnification, allowing visualization of capillary density, morphology, and architecture. Characteristic alterations in capillary patterns, such as capillary dilations, hemorrhages, and avascular areas, are indicative of SSc and can aid in International Journal of Current Pharmaceutical Review and Research e-ISSN: 0976-822X, p-ISSN: 2961-6042 Goswami et al. International Journal of Current Pharmaceutical Review and Research 649 distinguishing it from other connective tissue diseases [5]. Notably, the EULAR Study Group on Microcirculation in Rheumatic Diseases and the Scleroderma Clinical Trials Consortium have standardized nailfold capillaroscopy protocols to enhance diagnostic accuracy and reproducibility [6]. Dermoscopy, a non-invasive imaging technique that utilizes incident light to visualize subsurface structures, has also been employed to assess nailfold capillaries [7]. Handheld dermoscopes offer a portable and cost-effective alternative to traditional capillaroscopy, making them particularly useful in settings with limited access to specialized equipment [8]. Studies have demonstrated that dermoscopy can effectively detect capillary abnormalities in SSc patients, with findings comparable to those obtained through traditional capillaroscopy [9]. The integration of dermoscopy and nailfold capillaroscopy into clinical practice has facilitated the early identification of SSc, enabling timely intervention and improved patient outcomes [10]. Moreover, these imaging modalities have proven valuable in monitoring disease progression and assessing the efficacy of therapeutic interventions. For instance, alterations in capillary patterns have been correlated with the severity of internal organ involvement, such as pulmonary fibrosis and renal crisis, underscoring the prognostic significance of microvascular changes in SSc. In summary, the assessment of cutaneous profiles and nailfold capillaroscopy plays a crucial role in the diagnosis and management of systemic sclerosis. These noninvasive imaging techniques provide valuable insights into the microvascular alterations characteristic of SSc, facilitating early detection, monitoring of disease progression, and evaluation of therapeutic efficacy. As research advances, the refinement of these imaging modalities and the development of standardized protocols will further enhance their clinical utility, ultimately contributing to improved patient care in systemic sclerosis. Materials and Methods Study Design: cross-sectional observational study. Place of study: Calcutta school of tropical medicine. Period of study: 1 Year. Study Variables • Age • Gender • Disease duration • Subtype of SSc • Cutaneous Feature • Dermoscopy Pattern • Nailfold Finding • Capillaroscopy Pattern Sample Size: 80 Patients with systemic sclerosis (scleroderma). Inclusion Criteria • Patients diagnosed with systemic sclerosis based on ACR/EULAR 2013 criteria. • Age ≥18 years. • Both male and female patients. • Patients willing to give informed consent. Exclusion Criteria • Patients with other connective tissue disorders. • Pregnant or lactating women. • Patients with severe systemic illness preventing participation. • Patients on immunosuppressive therapy affecting nailfold findings. • Patients unwilling to participate. Statistical Analysis: Data collected in this study were entered into Microsoft Excel and analyzed using SPSS version 25.0. Continuous variables, such as age and disease duration, were expressed as mean ± standard deviation (SD), while categorical variables, such as gender and capillaroscopic patterns, were expressed as frequencies and percentages. Comparison between groups was performed using the Chi-square test or Fisher’s exact test for categorical variables and independent t-test or Mann–Whitney U test for continuous variables, as appropriate. Correlations between nailfold capillary changes and clinical parameters were assessed using Spearman’s rank correlation coefficient. A p-value <0.05 was considered statistically significant, and all analyses were two-tailed. Result Table 1: Demographic and Clinical Characteristics of Patients (n = 80) Demographic and Clinical Characteristics Parameter Value (n=80) % Age Age (mean ± SD) 42.6 ± 11.3 years – Gender Male 28 35% Female 52 65% Disease duration Disease duration (years, mean ± SD) 6.2 ± 3.5 – Subtype of SSc Limited cutaneous 50 62.50% Diffuse cutaneous 30 37.50% International Journal of Current Pharmaceutical Review and Research e-ISSN: 0976-822X, p-ISSN: 2961-6042 Goswami et al. International Journal of Current Pharmaceutical Review and Research 650 Table 2: Frequency of Cutaneous Manifestations in Scleroderma Patients Cutaneous Feature Number of Patients % Skin thickening 80 100% Raynaud’s phenomenon 70 87.50% Telangiectasia 48 60% Pigmentary changes 35 43.70% Digital ulcers 22 27.50% Table 3: Nailfold Dermoscopy Patterns in SSc Subtypes Dermoscopy Pattern Limited SSc (n=50) Diffuse SSc (n=30) p-value Normal 10 (20%) 2 (6.7%) 0.08 Early pattern 15 (30%) 4 (13.3%) 0.05 Active pattern 20 (40%) 12 (40%) 1 Late pattern 5 (10%) 12 (40%) 0.002 Table 4: Correlation between Nailfold Changes and Disease Duration Nailfold Finding Disease Duration (years, mean ± SD) r (Spearman) p-value Capillary density <7/mm 8.4 ± 3.2 0.42 0.001 Giant capillaries 7.9 ± 2.8 0.36 0.005 Microhemorrhages 6.5 ± 3.1 0.18 0.12 Table 5. Association between Digital Ulcers and Capillaroscopy Pattern Capillaroscopy Pattern Digital Ulcer Present Digital Ulcer Absent p-value Early 3 16 0.01 Active 8 24 0.03 Late 11 6 <0.001 Figure 1: Mean Disease Duration in SSc by Nailfold Capillaroscopy Patterns Figure 2: Nailfold Dermoscopy Patterns in SSc Subtypes International Journal of Current Pharmaceutical Review and Research e-ISSN: 0976-822X, p-ISSN: 2961-6042 Goswami et al. International Journal of Current Pharmaceutical Review and Research 651 A total of 80 patients with systemic sclerosis were included in the study. The mean age of the patients was 42.6 ± 11.3 years. Female patients predominated, accounting for 65% (n = 52) of the study population, while males constituted 35% (n = 28). The mean disease duration was 6.2 ± 3.5 years. Regarding the subtype of systemic sclerosis, 62.5% (n = 50) of patients had limited cutaneous systemic sclerosis, whereas 37.5% (n = 30) were diagnosed with diffuse cutaneous systemic sclerosis. All patients (100%, n = 80) exhibited skin thickening, which was the most consistent cutaneous feature observed in the study population. Raynaud’s phenomenon was present in 87.5% (n = 70) of patients, making it the second most common manifestation. Telangiectasia was noted in 60% (n = 48) of cases, while pigmentary changes were seen in 43.7% (n = 35) of patients. Digital ulcers were observed in 27.5% (n = 22), representing the least frequent among the major cutaneous features evaluated. Nailfold dermoscopy patterns varied between limited and diffuse cutaneous systemic sclerosis subtypes. In the limited SSc group (n = 50), 20% (n = 10) of patients showed a normal pattern, 30% (n = 15) had an early pattern, 40% (n = 20) exhibited an active pattern, and 10% (n = 5) demonstrated a late pattern. In contrast, among diffuse SSc patients (n = 30), 6.7% (n = 2) had a normal pattern, 13.3% (n = 4) an early pattern, 40% (n = 12) an active pattern, and 40% (n = 12) a late pattern. The difference in the late pattern between limited and diffuse SSc was statistically significant (p = 0.002), while the other patterns did not reach statistical significance (normal p = 0.08, early p = 0.05, active p = 1). Correlation analysis between nailfold dermoscopy findings and disease duration showed that patients with capillary density <7/mm had a mean disease duration of 8.4 ± 3.2 years, with a significant negative correlation (r = -0.42, p = 0.001). The presence of giant capillaries was associated with a mean disease duration of 7.9 ± 2.8 years and showed a significant positive correlation (r = 0.36, p = 0.005). Microhemorrhages were observed in patients with a mean disease duration of 6.5 ± 3.1 years, but the correlation with disease duration was not statistically significant (r = 0.18, p = 0.12). The association between nailfold capillaroscopy patterns and the presence of digital ulcers was analyzed. Among patients with an early pattern, 3 had digital ulcers while 16 did not (p = 0.01). In the active pattern group, 8 patients had digital ulcers and 24 were ulcer-free (p = 0.03). Notably, in the late pattern, 11 patients presented with digital ulcers compared to 6 without, demonstrating a highly significant association (p < 0.001). Discussion In our study of 80 patients with systemic sclerosis (SSc), all participants exhibited skin thickening, with Raynaud’s phenomenon observed in 87.5% of cases, telangiectasia in 60%, and pigmentary changes in 43.7%. Digital ulcers were noted in 27.5% of patients, representing the least frequent major cutaneous manifestation [1]. These findings are consistent with previous reports, which similarly describe high prevalence of skin thickening and Raynaud’s phenomenon as hallmarks of SSc [2,3]. Nailfold capillaroscopy patterns varied between subtypes, with 40% of limited cutaneous SSc (lcSSc) patients showing an active pattern and 40% of diffuse cutaneous SSc (dcSSc) patients exhibiting a late pattern. The difference in late pattern prevalence between subtypes was statistically significant (p = 0.002), consistent with prior studies reporting more severe microvascular damage in dcSSc [4,5]. Correlation analysis demonstrated a significant negative correlation between capillary density and disease duration (r = -0.42, p = 0.001) and a positive correlation between giant capillaries and disease duration (r = 0.36, p = 0.005). These findings align with literature showing progressive capillary loss and giant capillary formation as SSc advances [6,7]. Furthermore, the presence of digital ulcers was strongly associated with capillaroscopic patterns: early (p = 0.01), active (p = 0.03), and especially late patterns (p < 0.001). This supports the established role of late capillaroscopic changes as predictors of digital ulcers and severe disease manifestations [8,9]. Overall, our results reinforce the utility of nailfold capillaroscopy as a non-invasive tool for assessing disease severity, monitoring progression, and identifying patients at higher risk for digital ulcers in both lcSSc and dcSSc [10]. Longitudinal studies are needed to further validate these associations and guide clinical management. Conclusion In conclusion, our study demonstrates that skin thickening and Raynaud’s phenomenon remain the most consistent clinical features in patients with systemic sclerosis, with telangiectasia, pigmentary changes, and digital ulcers also contributing to disease morbidity. Nailfold capillaroscopy proved to be a valuable, non-invasive tool for assessing microvascular involvement, with distinct patterns correlating with disease subtype, duration, and severity. 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