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648
O iginal Resea ch A icle
Cu aneous P o ile and Nail Fold De moscopy in Pa ien s wi h Scle ode ma
Rik Goswami1, Saswa i Halde 2, P ojna Biswas3
1Senio Residen , MBBS, MD, Depa men o De ma ology, Calcu a School o T opical Medicine,
Kolka a, Wes Bengal 700073
2Head o Depa men , MBBS, MD, Depa men o De ma ology, Calcu a School o T opical Medicine,
Kolka a, Wes Bengal 700073
3Assis an P o esso , MBBS, MD, Depa men o De ma ology, Calcu a School o T opical Medicine,
Kolka a, Wes Bengal 700073
Recei ed: 01-06-2025 / Re ised: 16-07-2025 / Accep ed: 13-08-2025
Co esponding Au ho : D . Rik Goswami
Con lic o in e es : Nil
Abs ac
In oduc ion: Scle ode ma is a ch onic au oimmune connec i e issue diso de cha ac e ized by skin hickening,
ascula abno mali ies, and mul io gan in ol emen . Cu aneous mani es a ions o en p o ide ea ly diagnos ic
clues, and nail old capilla oscopy is an impo an non-in asi e ool o assess mic o ascula changes and disease
ac i i y.
Me hods: This c oss-sec ional obse a ional s udy was conduc ed o e a pe iod o one yea a he Calcu a School
o T opical Medicine. A o al o 80 pa ien s diagnosed wi h sys emic scle osis (SSc) we e en olled. Da a we e
collec ed on demog aphic a iables including age and gende , disease- ela ed ac o s such as disease du a ion and
SSc sub ype, as well as clinical cha ac e is ics including cu aneous ea u es. De ailed de moscopy and nail old
examina ions we e pe o med, and capilla oscopy pa e ns we e documen ed. All a iables we e sys ema ically
eco ded o assess hei associa ion wi h disease mani es a ions and nail old capilla oscopic indings.
Resul s: In his s udy o 80 sys emic scle osis pa ien s (mean age 42.6 ± 11.3 yea s; 65% emale), 62.5% had
limi ed cu aneous SSc and 37.5% had di use cu aneous SSc. All pa ien s exhibi ed skin hickening, wi h
Raynaud’s phenomenon (87.5%) and elangiec asia (60%) as common mani es a ions, while digi al ulce s we e
he leas equen (27.5%). Nail old capilla oscopy pa e ns di e ed by sub ype: limi ed SSc p edominan ly
showed ac i e pa e ns (40%), whe eas di use SSc equen ly exhibi ed la e pa e ns (40%), wi h a s a is ically
signi ican di e ence in he la e pa e n be ween sub ypes (p = 0.002). Capilla y densi y <7/mm co ela ed
nega i ely wi h disease du a ion ( = -0.42, p = 0.001), and gian capilla ies co ela ed posi i ely ( = 0.36, p =
0.005). Mic ohemo hages showed no signi ican co ela ion wi h disease du a ion. The p esence o digi al ulce s
was s ongly associa ed wi h capilla oscopic pa e ns, pa icula ly he la e pa e n (p < 0.001).
Conclusion: Cu aneous mani es a ions in scle ode ma a e di e se and p o ide impo an diagnos ic and
p ognos ic in o ma ion. Nail old de moscopy is a aluable, non-in asi e ool o de ec ing mic o ascula changes
and assessing disease se e i y, pa icula ly in di e en ia ing di use om limi ed scle ode ma and moni o ing
disease p og ession. Ea ly ecogni ion o de moscopic abno mali ies can aid in imely managemen and po en ially
imp o e ou comes.
Keywo ds: Scle ode ma, Cu aneous Mani es a ions, Nail Fold De moscopy, Mic o ascula Changes, Skin
Thickening, Au oimmune Connec i e Tissue Disease.
This is an Open Access a icle ha uses a unding model which does no cha ge eade s o hei ins i u ions o access and dis ibu ed unde
he e ms o he C ea i e Commons A ibu ion License (h p://c ea i ecommons.o g/licenses/by/4.0) and he Budapes Open Access Ini ia i e
(h p://www.budapes openaccessini ia i e.o g/ ead), which pe mi un es ic ed use, dis ibu ion, and ep oduc ion in any medium, p o ided
o iginal wo k is p ope ly c edi ed.
In oduc ion
Sys emic scle osis (SSc), also known as
scle ode ma, is a complex au oimmune connec i e
issue diso de cha ac e ized by widesp ead ib osis,
ascula al e a ions, and immune sys em
dys egula ion [1]. The disease encompasses wo
majo sub ypes: limi ed cu aneous sys emic
scle osis (lcSSc) and di use cu aneous sys emic
scle osis (dcSSc), each wi h dis inc clinical
p esen a ions and p ognos ic implica ions [2]. Ea ly
de ec ion and moni o ing o disease p og ession a e
c i ical o e ec i e managemen , and non-in asi e
imaging echniques ha e become indispensable
ools in his ega d [3]. Among hese echniques,
nail old capilla oscopy has eme ged as a pi o al
me hod o assessing mic o ascula changes in SSc
pa ien s [4]. This echnique in ol es he
examina ion o capilla ies a he nail old using high
magni ica ion, allowing isualiza ion o capilla y
densi y, mo phology, and a chi ec u e.
Cha ac e is ic al e a ions in capilla y pa e ns, such
as capilla y dila ions, hemo hages, and a ascula
a eas, a e indica i e o SSc and can aid in
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Goswami e al. In e na ional Jou nal o Cu en Pha maceu ical Re iew and Resea ch
649
dis inguishing i om o he connec i e issue
diseases [5]. No ably, he EULAR S udy G oup on
Mic oci cula ion in Rheuma ic Diseases and he
Scle ode ma Clinical T ials Conso ium ha e
s anda dized nail old capilla oscopy p o ocols o
enhance diagnos ic accu acy and ep oducibili y [6].
De moscopy, a non-in asi e imaging echnique ha
u ilizes inciden ligh o isualize subsu ace
s uc u es, has also been employed o assess nail old
capilla ies [7]. Handheld de moscopes o e a
po able and cos -e ec i e al e na i e o adi ional
capilla oscopy, making hem pa icula ly use ul in
se ings wi h limi ed access o specialized equipmen
[8]. S udies ha e demons a ed ha de moscopy can
e ec i ely de ec capilla y abno mali ies in SSc
pa ien s, wi h indings compa able o hose ob ained
h ough adi ional capilla oscopy [9]. The
in eg a ion o de moscopy and nail old
capilla oscopy in o clinical p ac ice has acili a ed
he ea ly iden i ica ion o SSc, enabling imely
in e en ion and imp o ed pa ien ou comes [10].
Mo eo e , hese imaging modali ies ha e p o en
aluable in moni o ing disease p og ession and
assessing he e icacy o he apeu ic in e en ions.
Fo ins ance, al e a ions in capilla y pa e ns ha e
been co ela ed wi h he se e i y o in e nal o gan
in ol emen , such as pulmona y ib osis and enal
c isis, unde sco ing he p ognos ic signi icance o
mic o ascula changes in SSc. In summa y, he
assessmen o cu aneous p o iles and nail old
capilla oscopy plays a c ucial ole in he diagnosis
and managemen o sys emic scle osis. These non-
in asi e imaging echniques p o ide aluable
insigh s in o he mic o ascula al e a ions
cha ac e is ic o SSc, acili a ing ea ly de ec ion,
moni o ing o disease p og ession, and e alua ion o
he apeu ic e icacy. As esea ch ad ances, he
e inemen o hese imaging modali ies and he
de elopmen o s anda dized p o ocols will u he
enhance hei clinical u ili y, ul ima ely con ibu ing
o imp o ed pa ien ca e in sys emic scle osis.
Ma e ials and Me hods
S udy Design: c oss-sec ional obse a ional s udy.
Place o s udy: Calcu a school o opical
medicine.
Pe iod o s udy: 1 Yea .
S udy Va iables
• Age
• Gende
• Disease du a ion
• Sub ype o SSc
• Cu aneous Fea u e
• De moscopy Pa e n
• Nail old Finding
• Capilla oscopy Pa e n
Sample Size: 80 Pa ien s wi h sys emic scle osis
(scle ode ma).
Inclusion C i e ia
• Pa ien s diagnosed wi h sys emic scle osis
based on ACR/EULAR 2013 c i e ia.
• Age ≥18 yea s.
• Bo h male and emale pa ien s.
• Pa ien s willing o gi e in o med consen .
Exclusion C i e ia
• Pa ien s wi h o he connec i e issue diso de s.
• P egnan o lac a ing women.
• Pa ien s wi h se e e sys emic illness p e en ing
pa icipa ion.
• Pa ien s on immunosupp essi e he apy
a ec ing nail old indings.
• Pa ien s unwilling o pa icipa e.
S a is ical Analysis: Da a collec ed in his s udy
we e en e ed in o Mic oso Excel and analyzed
using SPSS e sion 25.0. Con inuous a iables, such
as age and disease du a ion, we e exp essed as mean
± s anda d de ia ion (SD), while ca ego ical
a iables, such as gende and capilla oscopic
pa e ns, we e exp essed as equencies and
pe cen ages.
Compa ison be ween g oups was pe o med using
he Chi-squa e es o Fishe ’s exac es o
ca ego ical a iables and independen - es o
Mann–Whi ney U es o con inuous a iables, as
app op ia e. Co ela ions be ween nail old capilla y
changes and clinical pa ame e s we e assessed using
Spea man’s ank co ela ion coe icien . A p- alue
<0.05 was conside ed s a is ically signi ican , and all
analyses we e wo- ailed.
Resul
Table 1: Demog aphic and Clinical Cha ac e is ics o Pa ien s (n = 80)
Demog aphic and Clinical Cha ac e is ics
Pa ame e
Value (n=80)
%
Age
Age (mean ± SD)
42.6 ± 11.3 yea s
–
Gende
Male
28
35%
Female
52
65%
Disease du a ion
Disease du a ion (yea s,
mean ± SD)
6.2 ± 3.5
–
Sub ype o SSc
Limi ed cu aneous
50
62.50%
Di use cu aneous
30
37.50%
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Goswami e al. In e na ional Jou nal o Cu en Pha maceu ical Re iew and Resea ch
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Table 2: F equency o Cu aneous Mani es a ions in Scle ode ma Pa ien s
Cu aneous Fea u e
Numbe o Pa ien s
%
Skin hickening
80
100%
Raynaud’s phenomenon
70
87.50%
Telangiec asia
48
60%
Pigmen a y changes
35
43.70%
Digi al ulce s
22
27.50%
Table 3: Nail old De moscopy Pa e ns in SSc Sub ypes
De moscopy Pa e n
Limi ed SSc (n=50)
Di use SSc (n=30)
p- alue
No mal
10 (20%)
2 (6.7%)
0.08
Ea ly pa e n
15 (30%)
4 (13.3%)
0.05
Ac i e pa e n
20 (40%)
12 (40%)
1
La e pa e n
5 (10%)
12 (40%)
0.002
Table 4: Co ela ion be ween Nail old Changes and Disease Du a ion
Nail old Finding
Disease Du a ion (yea s, mean ± SD)
(Spea man)
p- alue
Capilla y densi y <7/mm
8.4 ± 3.2
0.42
0.001
Gian capilla ies
7.9 ± 2.8
0.36
0.005
Mic ohemo hages
6.5 ± 3.1
0.18
0.12
Table 5. Associa ion be ween Digi al Ulce s and Capilla oscopy Pa e n
Capilla oscopy Pa e n
Digi al Ulce P esen
Digi al Ulce Absen
p- alue
Ea ly
3
16
0.01
Ac i e
8
24
0.03
La e
11
6
<0.001
Figu e 1: Mean Disease Du a ion in SSc by Nail old Capilla oscopy Pa e ns
Figu e 2: Nail old De moscopy Pa e ns in SSc Sub ypes
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Goswami e al. In e na ional Jou nal o Cu en Pha maceu ical Re iew and Resea ch
651
A o al o 80 pa ien s wi h sys emic scle osis we e
included in he s udy. The mean age o he pa ien s
was 42.6 ± 11.3 yea s. Female pa ien s
p edomina ed, accoun ing o 65% (n = 52) o he
s udy popula ion, while males cons i u ed 35% (n =
28). The mean disease du a ion was 6.2 ± 3.5 yea s.
Rega ding he sub ype o sys emic scle osis, 62.5%
(n = 50) o pa ien s had limi ed cu aneous sys emic
scle osis, whe eas 37.5% (n = 30) we e diagnosed
wi h di use cu aneous sys emic scle osis.
All pa ien s (100%, n = 80) exhibi ed skin
hickening, which was he mos consis en cu aneous
ea u e obse ed in he s udy popula ion. Raynaud’s
phenomenon was p esen in 87.5% (n = 70) o
pa ien s, making i he second mos common
mani es a ion. Telangiec asia was no ed in 60% (n =
48) o cases, while pigmen a y changes we e seen in
43.7% (n = 35) o pa ien s. Digi al ulce s we e
obse ed in 27.5% (n = 22), ep esen ing he leas
equen among he majo cu aneous ea u es
e alua ed.
Nail old de moscopy pa e ns a ied be ween
limi ed and di use cu aneous sys emic scle osis
sub ypes. In he limi ed SSc g oup (n = 50), 20% (n
= 10) o pa ien s showed a no mal pa e n, 30% (n =
15) had an ea ly pa e n, 40% (n = 20) exhibi ed an
ac i e pa e n, and 10% (n = 5) demons a ed a la e
pa e n. In con as , among di use SSc pa ien s (n =
30), 6.7% (n = 2) had a no mal pa e n, 13.3% (n =
4) an ea ly pa e n, 40% (n = 12) an ac i e pa e n,
and 40% (n = 12) a la e pa e n. The di e ence in he
la e pa e n be ween limi ed and di use SSc was
s a is ically signi ican (p = 0.002), while he o he
pa e ns did no each s a is ical signi icance (no mal
p = 0.08, ea ly p = 0.05, ac i e p = 1).
Co ela ion analysis be ween nail old de moscopy
indings and disease du a ion showed ha pa ien s
wi h capilla y densi y <7/mm had a mean disease
du a ion o 8.4 ± 3.2 yea s, wi h a signi ican
nega i e co ela ion ( = -0.42, p = 0.001). The
p esence o gian capilla ies was associa ed wi h a
mean disease du a ion o 7.9 ± 2.8 yea s and showed
a signi ican posi i e co ela ion ( = 0.36, p =
0.005). Mic ohemo hages we e obse ed in
pa ien s wi h a mean disease du a ion o 6.5 ± 3.1
yea s, bu he co ela ion wi h disease du a ion was
no s a is ically signi ican ( = 0.18, p = 0.12). The
associa ion be ween nail old capilla oscopy pa e ns
and he p esence o digi al ulce s was analyzed.
Among pa ien s wi h an ea ly pa e n, 3 had digi al
ulce s while 16 did no (p = 0.01). In he ac i e
pa e n g oup, 8 pa ien s had digi al ulce s and 24
we e ulce - ee (p = 0.03). No ably, in he la e
pa e n, 11 pa ien s p esen ed wi h digi al ulce s
compa ed o 6 wi hou , demons a ing a highly
signi ican associa ion (p < 0.001).
Discussion
In ou s udy o 80 pa ien s wi h sys emic scle osis
(SSc), all pa icipan s exhibi ed skin hickening,
wi h Raynaud’s phenomenon obse ed in 87.5% o
cases, elangiec asia in 60%, and pigmen a y
changes in 43.7%. Digi al ulce s we e no ed in
27.5% o pa ien s, ep esen ing he leas equen
majo cu aneous mani es a ion [1]. These indings
a e consis en wi h p e ious epo s, which simila ly
desc ibe high p e alence o skin hickening and
Raynaud’s phenomenon as hallma ks o SSc [2,3].
Nail old capilla oscopy pa e ns a ied be ween
sub ypes, wi h 40% o limi ed cu aneous SSc
(lcSSc) pa ien s showing an ac i e pa e n and 40%
o di use cu aneous SSc (dcSSc) pa ien s exhibi ing
a la e pa e n. The di e ence in la e pa e n
p e alence be ween sub ypes was s a is ically
signi ican (p = 0.002), consis en wi h p io s udies
epo ing mo e se e e mic o ascula damage in
dcSSc [4,5]. Co ela ion analysis demons a ed a
signi ican nega i e co ela ion be ween capilla y
densi y and disease du a ion ( = -0.42, p = 0.001)
and a posi i e co ela ion be ween gian capilla ies
and disease du a ion ( = 0.36, p = 0.005). These
indings align wi h li e a u e showing p og essi e
capilla y loss and gian capilla y o ma ion as SSc
ad ances [6,7].
Fu he mo e, he p esence o digi al ulce s was
s ongly associa ed wi h capilla oscopic pa e ns:
ea ly (p = 0.01), ac i e (p = 0.03), and especially la e
pa e ns (p < 0.001). This suppo s he es ablished
ole o la e capilla oscopic changes as p edic o s o
digi al ulce s and se e e disease mani es a ions
[8,9]. O e all, ou esul s ein o ce he u ili y o
nail old capilla oscopy as a non-in asi e ool o
assessing disease se e i y, moni o ing p og ession,
and iden i ying pa ien s a highe isk o digi al
ulce s in bo h lcSSc and dcSSc [10]. Longi udinal
s udies a e needed o u he alida e hese
associa ions and guide clinical managemen .
Conclusion
In conclusion, ou s udy demons a es ha skin
hickening and Raynaud’s phenomenon emain he
mos consis en clinical ea u es in pa ien s wi h
sys emic scle osis, wi h elangiec asia, pigmen a y
changes, and digi al ulce s also con ibu ing o
disease mo bidi y. Nail old capilla oscopy p o ed o
be a aluable, non-in asi e ool o assessing
mic o ascula in ol emen , wi h dis inc pa e ns
co ela ing wi h disease sub ype, du a ion, and
se e i y.
No ably, he la e capilla oscopic pa e n was
s ongly associa ed wi h he p esence o digi al
ulce s, unde sco ing i s p ognos ic signi icance in
iden i ying pa ien s a highe isk o se e e
complica ions.
Re e ences
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Goswami e al. In e na ional Jou nal o Cu en Pha maceu ical Re iew and Resea ch
652
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