Assessment of nailfold capillaroscopy in systemic sclerosis by different optical magnification methods

Authors

  • N. G. Mazzotti,

    Corresponding author
    1. Department of Dermatology, School of Medicine, Hospital de Clinicas de Porto Alegre, University of Rio Grande do Sul, Porto Alegre, Brazil
    • Correspondence: Dr Nicolle Gollo Mazzotti, Department of Dermatology, School of Medicine, Hospital de Clinicas de Porto Alegre, University of Rio Grande do Sul, Rua Ramiro Barcelos, 2350 – CEP, Porto Alegre, Rio Grande do Su, 90035-903, Brazil

      E-mail: nicollemazzotti@gmail.com

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  • M. Bredemeier,

    1. Department of Rheumatology, School of Medicine, Hospital de Clinicas de Porto Alegre, University of Rio Grande do Sul, Porto Alegre, Brazil
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  • C. V. Brenol,

    1. Department of Rheumatology, School of Medicine, Hospital de Clinicas de Porto Alegre, University of Rio Grande do Sul, Porto Alegre, Brazil
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  • R. M. Xavier,

    1. Department of Rheumatology, School of Medicine, Hospital de Clinicas de Porto Alegre, University of Rio Grande do Sul, Porto Alegre, Brazil
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  • T. F. Cestari

    1. Department of Dermatology, School of Medicine, Hospital de Clinicas de Porto Alegre, University of Rio Grande do Sul, Porto Alegre, Brazil
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  • Conflict of interest: none declared.

Summary

Background

Systemic sclerosis (SSc) is characterized by target-organ fibrosis and microvascular dysfunction, which can be assessed using nailfold capillaroscopy. Dermoscopy is a useful and easily performed method for diagnosing skin lesions.

Aim

To compare conventional capillaroscopy, using the gold-standard method (conventional stereomicroscope nailfold capillaroscopy; SNFC), with polarized light noncontact dermoscopy (PNCD) and nonpolarized light contact dermoscopy (NPCD), and to evaluate their accuracy in diagnosing characteristic SSc-related alterations.

Methods

The study enrolled 45 patients with SSc. Capillaroscopy images and photographs were taken with three devices, SNFC, NPCD and PNCD, and these images were randomly analysed by a blinded observer.

Results

The scleroderma pattern was found in 83% of patients. PNCD and NPCD were highly sensitive in identifying the presence of focal capillary loss (96.4% and 100%, respectively), haemorrhage (96.2% and 92%, respectively), and scleroderma (91.9%, 94.6%), and showed high specificity for haemorrhage and enlarged loops. The intra-observer kappa values for detection of the scleroderma pattern by SNFC images, NPCD and PNCD were moderate to good: (κ = 0.71 (95% CI 0.44–0.95), κ = 0.60 (95% CI 0.35–0.83) and κ = 0.60 (95% CI 0.32–0.86), respectively. Evaluation of haemorrhage presence gave high kappa values for all methods: κ = 0.77 (95% CI 0.57–0.95), κ = 0.90 (95% CI 0.76–1.00) and κ = 0.95 (95% CI 0.85–1.00), respectively.

Conclusions

Both polarized and nonpolarized dermoscopy are reliable methods for valuation of nailfold capillaroscopy in patients with SSc. They are easy to perform, with good rates of accuracy and results that are comparable with traditional capillaroscopy.

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