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Abstract
Idiopathic inflammatory myopathies (IIMs) are a diverse group of diseases characterized by proximal muscle weakness and inflammation in skeletal muscle. Phenotypically, the subtypes include dermatomyositis, polymyositis, inclusion body myositis, and amyopathic dermatomyositis. The most common IIM in children is juvenile dermatomyositis (JDM). In contrast to adult dermatomyositis (DM), children are likely to have frequent relapses, vasculopathy, and long-term metabolic and other complications like lipodystrophy, insulin resistance, and calcinosis. Significant advances in our understanding of pathogenesis, disease course, and treatment of JDM has changed the therapeutic landscape and improved outcomes in children. Myositis-specific autoantibodies and myositis-associated autoantibodies have unique clinical associations, disease course and help predict response to therapy. A multidisciplinary approach including exercise programs and psychosocial support is essential. The first line of treatment is a combination of corticosteroids and methotrexate (MTX). Other targeted immunosuppressive therapy is used in refractory cases. Early recognition and timely referral to a specialist center remain pivotal to improving the mortality and morbidity associated with this disease.
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Affiliation(s)
- Suma Balan
- Department of Rheumatology and Clinical Immunology, Amrita Institute of Medical Sciences and Research Centre, Ponekkara, Kochi, Kerala, 682 041, India.
| | - Sumanth Madan
- Department of Rheumatology and Clinical Immunology, Amrita Institute of Medical Sciences and Research Centre, Ponekkara, Kochi, Kerala, 682 041, India
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2
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Baroutidou A, Arvanitaki A, Pagkopoulou E, Anyfanti P, Ziakas A, Kamperidis V, Giannakoulas G, Dimitroulas T. Nailfold videocapillaroscopy as a non-invasive tool for the assessment of peripheral microangiopathy in cardiovascular diseases. J Hypertens 2024:00004872-990000000-00543. [PMID: 39288254 DOI: 10.1097/hjh.0000000000003873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2024]
Abstract
Cardiovascular disease (CVD) remains the main cause of morbidity and mortality worldwide. Accumulating evidence supports the presence of endothelial and microvascular dysfunction in CVD, which can be assessed using several methods in peripheral organs and tissues. Naifold videocapillaroscopy (NVC) is an established, noninvasive, easily applicable technique for the assessment of peripheral microcirculation. There is limited capillaroscopic data in the field of CVD, though, and the diagnostic or possible prognostic significance of the capillaroscopic alterations in this population is still a matter of research. This review aims to summarize the current knowledge on the capillaroscopic findings in patients with cardiovascular risk factors or established atherosclerotic and nonatherosclerotic CVD, focusing on the possible correlations of these alterations with clinical and laboratory markers of cardiac function.
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Affiliation(s)
| | | | - Eleni Pagkopoulou
- Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School
| | - Panagiota Anyfanti
- Second Medical Department, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | | | - Theodoros Dimitroulas
- Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School
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3
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Sechi A, Wortsman X, Tosti A, Iorizzo M. Advances in image-based diagnosis of nail disorders. J Eur Acad Dermatol Venereol 2024. [PMID: 39230323 DOI: 10.1111/jdv.20309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 07/02/2024] [Indexed: 09/05/2024]
Abstract
This paper provides a comprehensive overview of image-based techniques, particularly focusing on their applications and advancements in the context of nail disorders. Nowadays, high-resolution digital cameras and dermoscopes enable dermatologists to capture detailed images of nail abnormalities, facilitating early diagnosis and meticulous tracking of disease progression. Onychoscopy is now a routine technique with well-known criteria for the diagnosis, but recent developments allow us to visualize certain diseases better. Imaging modalities like high-frequency ultrasound, magnetic resonance imaging, optical coherence tomography and confocal microscopy are being increasingly adopted for their superior diagnostic capabilities. These techniques are described in their technology, scanning protocols, normal findings, advantages and limitations. Moreover, the integration of technology in patient education has fostered a more informed patient population, capable of actively participating in their disease monitoring and treatment regimens. Proper training, validation, regulation and ethical considerations are, however, essential when integrating technology into healthcare practices. Imaging technologies that present the potential to add critical anatomical information to clinical diagnoses within reasonable costs and are available worldwide are the ones that will probably be used the most.
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Affiliation(s)
- Andrea Sechi
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Ximena Wortsman
- Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
- Department of Dermatology, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- Department of Dermatology, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Institute for Diagnostic Imaging and Research of the Skin and Soft Tissues, Santiago, Chile
| | - Antonella Tosti
- Fredric Brandt Endowed Professor of Dermatology - Mille School of Medicine, University of Miami, Miami, Florida, USA
| | - Matilde Iorizzo
- Private Dermatology Practice, Bellinzona/Lugano, Switzerland
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4
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Aggarwal B, Gandhi V, Singal A, Aggarwal A, Saha S. Nail fold capillaroscopy in leprosy: Unveiling the microvascular changes. Microvasc Res 2024; 155:104712. [PMID: 38909952 DOI: 10.1016/j.mvr.2024.104712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 06/17/2024] [Accepted: 06/20/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND Leprosy, a chronic infectious disease, is associated with various nail changes. Its etiopathogenesis is multifaceted, with microvascular damage being crucial. Nail fold capillaroscopy (NFC) emerges as a novel tool for detecting early vascular deficits in leprosy. The study aimed to assess and provide a complete clinical characterization of NFC changes in leprosy patients. METHODS It is an observational cross-sectional study, done over a period of 1.5 year (January 2021 to august 2022) in a tertiary care hospital, encompassing 60 patients diagnosed with leprosy (18-60 years). After obtaining informed consent; detailed history, complete cutaneous and neurological examinations were conducted. All fingernails and toenails were examined for clinical changes. Subsequently, onychoscopy was performed using USB type of video-dermatoscope (Model AM7115MZT Dino-lite), a non-invasive tool. This was followed by NFC which was done for all fingernails and images were recorded by single operator, which were then assessed for quantitative and qualitive changes and statistical analysis was conducted using SPSS v20, with mean capillary density compared using Student's t-test, morphological change frequencies assessed by proportions, and group comparisons made using Chi-square or Fischer exact tests, with a significance threshold of p < 0.05. RESULTS Among the 60 patients, 39 were in the lepromatous group, which included both borderline lepromatous (BL) and lepromatous leprosy (LL) patients, and 17 were in the tuberculoid group, which included borderline tuberculoid (BT) leprosy patients; 23.3 % had Type 1 reactions, and 18.3 % had Type 2 reactions. Nail fold capillaroscopy (NFC) showed microvasculature changes in 93.3 % of patients. The average capillary density was 6.8 ± 1.5 capillaries per mm, with the lepromatous group having a lower density (6.5 ± 1.09) compared to the tuberculoid group (7.0 ± 0.86). The most common NFC changes in the tuberculoid group were tortuous capillaries (70 %), capillary dropouts, and dilated capillaries (both 64.7 %). In the lepromatous group, capillary dropouts (82 %) were most frequent, followed by tortuous (69 %), receding (69 %), and dilated capillaries (66 %). A dilated and prominent subpapillary plexus was more common in the lepromatous group (35 %, p = 0.04). Patients with trophic changes in the lepromatous group had more capillary dropouts and bizarre capillaries. Capillary dropouts, dilated capillaries, and visible subpapillary venous plexus were more prevalent in patients with Type 2 reactions. CONCLUSION NFC changes are prevalent in both tuberculoid and lepromatous leprosy, which may be an indicator of peripheral vascular compromise and trophic changes, especially in lepromatous leprosy. NFC can be an auxiliary tool for detecting microvascular abnormalities in leprosy patients.
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Affiliation(s)
- Bharti Aggarwal
- Department of Dermatology & STD, University College of Medical Sciences & GTB, Hospital, Delhi, India.
| | - Vijay Gandhi
- Department of Dermatology & STD, University College of Medical Sciences & GTB, Hospital, Delhi, India
| | - Archana Singal
- Department of Dermatology & STD, University College of Medical Sciences & GTB, Hospital, Delhi, India
| | - Amitesh Aggarwal
- Department of Medicine, University College of Medical Sciences & GTB, Hospital, Delhi, India
| | - Sushobhan Saha
- Department of Dermatology & STD, University College of Medical Sciences & GTB, Hospital, Delhi, India
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Liang CM, Lee W, Chou CC, Tung H, Chen HC, Chen HM, Lee WJ, Chen YM. Nailfold capillary measurements correlated to NOTCH3 R544C mutation in preclinical CADASIL patients. J Neurol Sci 2024; 462:123109. [PMID: 38941707 DOI: 10.1016/j.jns.2024.123109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/23/2024] [Accepted: 06/22/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is a hereditary disease caused by NOTCH3 mutation. Nailfold capillaroscopy is a non-invasive technique typically used for rheumatic diseases. It has potential in other conditions linked to vascular pathology. However, capillaroscopy in CADASIL has not been explored. This study aims to investigate whether capillaroscopy measurements can correlate with brain vascular changes in preclinical CADASIL patients, specifically those with NOTCH3 mutation. METHODS This study included 69 participants from the Taiwan Precision Medicine Initiative (TPMI) dataset who visited Taichung Veterans General Hospital from January to December 2022. All individuals underwent genetic studies, brain imaging and nailfold capillaroscopy. The Mann-Whitney U test was used to compare results of brain imaging between carriers and controls. It was also used to compare measurements in nailfold capillaroscopy within each group. Spearman Rank Correlation Analysis was used to explore the relationship between capillary measurements and brain MRI results. RESULTS White matter hyperintensities (WMH) expression was positively correlated with capillary dimension and negatively correlated with density. Our results presented that R544C carriers exhibited a diffuse increase in WMH (p < 0.001) and a global reduction in gray matter volume but preserved in specific areas. The white matter lesion scores in all brain regions were higher in the mutation carriers than the controls. (p < 0.001). CONCLUSION This research highlights the association of nailfold capillaroscopy findings with white matter lesions in preclinical CADASIL patients. Capillaroscopy guides an effective screening strategy in individuals with NOTCH3 mutations.
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Affiliation(s)
- Chun-Min Liang
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Wei Lee
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Chien-Chih Chou
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsin Tung
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan; Center of Faculty Development, Taichung Veterans General Hospital, Taichung, Taiwan; Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hung-Chieh Chen
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Division of Neuroradiology, Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hsian-Min Chen
- Center for Quantitative Imaging in Medicine, Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wei-Ju Lee
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan; Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan; Dementia Center, Taichung Veterans General Hospital, Taichung, Taiwan; Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Ming Chen
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Biomedical Science and Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan; Precision Medicine Research Center, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
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Mormile I, Gigliotti MC, Ferrara AL, Gatti R, Spadaro G, de Paulis A, Loffredo S, Bova M, Petraroli A. Clinical features and potential markers of disease in idiopathic non-histaminergic angioedema, a real-life study. Immunol Res 2024:10.1007/s12026-024-09501-9. [PMID: 38829492 DOI: 10.1007/s12026-024-09501-9] [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: 01/12/2024] [Accepted: 05/27/2024] [Indexed: 06/05/2024]
Abstract
Idiopathic non-histaminergic acquired angioedema (InH-AAE) is a rare disease, with unknown etiology and pathogenesis, characterized by recurrent clinical manifestations and resistance to antihistamines and corticosteroids. We aim to evaluate clinical features and potential markers of disease in an Italian cohort of patients with InH-AAE. We enrolled 26 patients diagnosed with InH-AAE. Information about clinical features, treatments, routine laboratory investigations, immunological and genetic tests were collected. We assessed plasma levels of complement components, angiogenic and lymphangiogenic mediators, proinflammatory cytokines and chemokines, and activity of phospholipases A2. Finally, patients underwent nailfold videocapillaroscopy (NVC); both quantitative and qualitative capillaroscopic parameters were analyzed. Plasma levels of VEGFs were similar in healthy controls and in InH-AAE patients. ANGPT1 was decreased in InH-AAE patients compared to controls while ANGPT2 was similar to controls. Interestingly, the ANGPT2/ANGPT1 ratio (an index of vascular permeability) was increased in InH-AAE patients compared to controls. sPLA2 activity, elevated in patients with C1-INH-HAE, showed differences also when measured in InH-AAE patients. TNF-α concentration was higher in InH-AAE patients than in healthy controls, conversely, the levels of CXCL8, and IL-6 were similar in both groups. At the NVC, the capillary loops mainly appeared short and tortuous in InH-AAE patients. InH-AAE represents a diagnostic challenge. Due to the potential life-threatening character of this condition, a prompt identification of the potentially bradykinin-mediated forms is crucial. A better comprehension of the mechanism involved in InH-AAE would also lead to the development of new therapeutic approaches to improve life quality of patients affected by this disabling disease.
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Affiliation(s)
- Ilaria Mormile
- Department of Translational Medical Sciences, University of Naples Federico II, Via Sergio Pansini 5, Naples, 80131, Italy
| | - Maria Celeste Gigliotti
- Department of Translational Medical Sciences, University of Naples Federico II, Via Sergio Pansini 5, Naples, 80131, Italy
| | - Anne Lise Ferrara
- Department of Translational Medical Sciences, University of Naples Federico II, Via Sergio Pansini 5, Naples, 80131, Italy
- Center for Basic and Clinical Immunology Research (CISI), WAO Center of Excellence, University of Naples Federico II, Naples, Italy
| | - Roberta Gatti
- Post-Graduate Program in Clinical Immunology and Allergy, University of Naples Federico II, Naples, Italy
| | - Giuseppe Spadaro
- Department of Translational Medical Sciences, University of Naples Federico II, Via Sergio Pansini 5, Naples, 80131, Italy
- Center for Basic and Clinical Immunology Research (CISI), WAO Center of Excellence, University of Naples Federico II, Naples, Italy
| | - Amato de Paulis
- Department of Translational Medical Sciences, University of Naples Federico II, Via Sergio Pansini 5, Naples, 80131, Italy
- Center for Basic and Clinical Immunology Research (CISI), WAO Center of Excellence, University of Naples Federico II, Naples, Italy
| | - Stefania Loffredo
- Department of Translational Medical Sciences, University of Naples Federico II, Via Sergio Pansini 5, Naples, 80131, Italy
- Center for Basic and Clinical Immunology Research (CISI), WAO Center of Excellence, University of Naples Federico II, Naples, Italy
- Institute of Experimental Endocrinology and Oncology "G. Salvatore" (IEOS), National Research Council (CNR), Naples, Italy
| | - Maria Bova
- Department of Translational Medical Sciences, University of Naples Federico II, Via Sergio Pansini 5, Naples, 80131, Italy.
- Department of Internal Medicine, A.O.R.N. Antonio Cardarelli, Naples, Italy.
| | - Angelica Petraroli
- Department of Translational Medical Sciences, University of Naples Federico II, Via Sergio Pansini 5, Naples, 80131, Italy
- Center for Basic and Clinical Immunology Research (CISI), WAO Center of Excellence, University of Naples Federico II, Naples, Italy
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7
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Hwang JK, Grover C, Iorizzo M, Lebwohl MG, Piraccini BM, Rigopoulos DG, Lipner SR. Nail psoriasis and nail lichen planus: Updates on diagnosis and management. J Am Acad Dermatol 2024; 90:585-596. [PMID: 38007038 DOI: 10.1016/j.jaad.2023.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 10/30/2023] [Accepted: 11/17/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Inflammatory diseases of the nail, including nail psoriasis and nail lichen planus, are associated with significant disease burden and have a negative impact on quality of life. Diagnosis is often delayed, especially when patients present without cutaneous findings. Therefore, recognizing clinical signs and symptoms of inflammatory nail diseases, and initiating timely and appropriate treatment, is of utmost importance. OBJECTIVE We review recent studies on diagnostic techniques, discuss severity grading and scoring systems, and describe consensus treatment recommendations for nail psoriasis and nail lichen planus. METHODS An updated literature review was performed using the PubMed database on studies assessing diagnostic techniques or treatment modalities for nail psoriasis and nail lichen planus. RESULTS Recent studies on diagnostic techniques for inflammatory nail disease have focused on use of dermoscopy, capillaroscopy, and ultrasound modalities. Treatment of these conditions is dichotomized into involvement of few (≤3) or many (>3) nails. Recent psoriatic therapeutics studied for nail outcomes include brodalumab, tildrakizumab, risankizumab, deucravacitinib, and bimekizumab, while emerging treatments for nail lichen planus include JAK inhibitors and intralesional platelet rich plasma injections. CONCLUSIONS We emphasize the need for increased awareness and expanded management strategies for inflammatory nail diseases to improve patient outcomes.
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Affiliation(s)
- Jonathan K Hwang
- Department of Dermatology, Weill Cornell Medicine, New York, New York
| | - Chander Grover
- Department of Dermatology, University College of Medical Sciences, New Delhi, India
| | | | - Mark G Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Bianca M Piraccini
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Dimitris G Rigopoulos
- 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Athens, Greece
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, New York.
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Elumalai S, Krishnamoorthi N, Periyasamy N, Farazullah M, Raj K, Mahadevan S. Analysis of microvascular pattern in diabetes mellitus condition using the nailfold capillaroscopy images. Proc Inst Mech Eng H 2024; 238:340-347. [PMID: 38279673 DOI: 10.1177/09544119231224510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
Diabetes is often considered a vascular disease due to its impact on blood vessels, it is a complex condition with various metabolic and autoimmune factors involved. One of the long term comorbidities of diabetes includes microvascular complications. The microvascular complications can be analyzed using the Nailfold capillaroscopy, a non-invasive technique that allows for the visualization and analysis of capillaries in the proximal nailfold area. Using advanced video capillaroscopy with high magnification, capillary images can be captured from and processed to analyze their morphology. The capillary images of normal group and diabetic group are acquired from 118 participants using nailfold capillaroscopy and the obtained images are preprocessed using image processing filters. The identification and segmentation of the capillaries are the challenges to be addressed in the processing of the images. Hence segmentation of capillaries is done using morphological operations, thresholding and convolutional neural networks. The performance of the filters and segmentation methods are evaluated using Mean Square Error (MSE), Peak signal to Noise Ratio (PSNR), Structural Similarity Index Measure (SSIM), Jaccard Index and Sorensen coefficient. By analyzing the morphological features namely the capillary diameter, density, distribution, presence of hemorrhage and the shape of the capillaries from both the groups, the capillary changes associated with diabetic condition were studied. It was found that the non diabetic participants considered in this study has capillary diameter in the range of 8-14 µm and the capillary density in the range of 10-30 capillaries per mm2 whereas the diabetic participants has capillary diameter greater than 30 µm and the capillary density is less than 10 capillaries per mm2. In addition to capillary density and diameter, the presence of hemorrhage, the orientation and distribution of the capillaries are also considered to differentiate the diabetic group from the non diabetic group. The classification of the participants are validated with the clinical history of the participants.
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Affiliation(s)
- Sowmiya Elumalai
- Department of Biomedical Engineering, Sri Sivasubramaniya Nadar College of Engineering, Chennai, Tamil Nadu, India
| | - Nirmala Krishnamoorthi
- Department of Biomedical Engineering, Sri Sivasubramaniya Nadar College of Engineering, Chennai, Tamil Nadu, India
| | - Naveen Periyasamy
- Department of Biomedical Engineering, Sri Sivasubramaniya Nadar College of Engineering, Chennai, Tamil Nadu, India
| | - Mohamed Farazullah
- Department of Biomedical Engineering, Sri Sivasubramaniya Nadar College of Engineering, Chennai, Tamil Nadu, India
| | - Kiran Raj
- Department of Biomedical Engineering, Sri Sivasubramaniya Nadar College of Engineering, Chennai, Tamil Nadu, India
| | - Shriraam Mahadevan
- Department of Endocrinology, Sri Ramachandra Medical College and Hospital, Chennai, Tamil Nadu, India
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9
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Pal V, Relhan V, Sahoo B. A comparative observational study of nailfold capillaroscopy in psoriatic patients and healthy controls using a USB videodermatoscope. Australas J Dermatol 2023; 64:e400-e402. [PMID: 37743580 DOI: 10.1111/ajd.14163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/31/2023] [Accepted: 09/07/2023] [Indexed: 09/26/2023]
Affiliation(s)
- Vishal Pal
- Department of Dermatology, Maulana Azad Medical College and Associated Lok Nayak Hospital, G.I.P.M.E.R and G.N.E.C., University of Delhi, New Delhi, India
| | - Vineet Relhan
- Department of Dermatology, Maulana Azad Medical College and Associated Lok Nayak Hospital, G.I.P.M.E.R and G.N.E.C., University of Delhi, New Delhi, India
| | - Bijaylaxmi Sahoo
- Department of Dermatology, Maulana Azad Medical College and Associated Lok Nayak Hospital, G.I.P.M.E.R and G.N.E.C., University of Delhi, New Delhi, India
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10
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Alenzi F, D’Cruz DP. Reversible Cerebral Vasoconstriction Syndrome and Raynaud's Phenomenon: Is There a Link between the Pathogeneses of Their Underlying Complex Etiology? A Case Report and Literature Review. Diagnostics (Basel) 2023; 13:2951. [PMID: 37761318 PMCID: PMC10528332 DOI: 10.3390/diagnostics13182951] [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: 08/02/2023] [Revised: 09/10/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
Reversible cerebral vasoconstriction syndrome (RCVS) typically manifests as a sudden, severe thunderclap headache due to narrowing of the cerebral arteries. Symptoms usually resolve within three months. An imbalance in cerebral vascular tone, an abnormal endothelial function, and a decreased autoregulation of cerebral blood flow are thought to be involved in the pathogenesis of RCVS. However, the precise origin of this condition is not yet fully understood. Symptoms of Raynaud's phenomenon (RP) include vasospasm of arterioles of the digits. The pathophysiology of RP includes interactions between the endothelium, smooth muscle, and autonomic and sensory neurons that innervate arteries to help maintain vasomotor homeostasis. RP may occur before the clinical manifestation of a rheumatic condition. RCVS is rare in patients with autoimmune rheumatic disease. We describe a 54-year-old female who had a history of Raynaud's phenomenon affecting her fingers and toes since the age of 12 years. The patient was diagnosed with RCVS in 2012. She described RCVS precipitants, including the regular use of cannabis, cocaine, and amphetamine and tobacco smoking. In 2021, she presented with oral ulcers, intermittent swallowing difficulties, and Raynaud's phenomenon. Clinical examination revealed early sclerodactyly, and abnormal nail-fold capillaroscopy showed multiple giant capillaries, dilated capillary loops, and areas of capillary hemorrhage with capillary drop-out. The investigation revealed positive ANA, strongly positive SRP antibodies, and Ro60 antibodies. Our case report indicates that there may be a correlation between RCVS and Raynaud's phenomenon, and a potential connection between RCVS and autoimmune rheumatic diseases. Hence, physicians must be aware of the red flags and subtle differences in neurological abnormalities, such as headaches, in patients with autoimmune rheumatic diseases who have an inactive clinical status to improve patient care and outcomes.
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Affiliation(s)
- Fahidah Alenzi
- Clinical Sciences Department, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh 11564, Saudi Arabia
| | - David P D’Cruz
- Louise Coote Lupus Unit, Guy’s Hospital, Guy’s and St. Thomas’ Hospitals, NHS Foundation Trust, London SE1 9RT, UK
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Ahmad S, Pai VV, Sharath A, Ghodge R, Shukla P. Qualitative analysis of nailfold capillaries in diabetes and diabetic retinopathy using dermatoscope in patients with coloured skin. Indian J Dermatol Venereol Leprol 2023:1-8. [PMID: 37067132 DOI: 10.25259/ijdvl_710_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/01/2022] [Indexed: 03/19/2023]
Abstract
Introduction
Diabetes mellitus (DM) is associated with significant morbidity and mortality due to vascular complications. Diabetic retinopathy (DR) is the most common microvascular complication of diabetes. Videocapillaroscope has been the predominant tool for nailfold capillary analysis. We aimed at using the commonly available handheld dermatoscope and observe changes in the nailfold capillaries as a part of evaluating diabetic microvascular involvement.
Materials and methods
A cross-sectional observational study involving 262 patients of diabetes mellitus and 150 controls was conducted for nailfold capillaroscopic changes using a hand-held dermatoscope over a period of 1 year.
Results
All the capillaroscopic variables like tortuosity, increased capillary density, neoangiogenesis, microhaemorrhages, avascular areas, crossing and meandering capillaries and receding capillaries were significantly more among diabetic than healthy controls. Patients with diabetic retinopathy had significant nailfold capillaroscopic features as compared to patients without DR (P value < 0.001). Neoangiogenesis, receding capillaries and avascular area were significantly higher in proliferative DR as against nonproliferative DR (P < 0.001). A positive association was found between the duration of DM and HbA1c values and NFC features. A decrease in the visualisation of NFC features was noted with increasing skin tone. The difference was significantly more between Fitzpatrick skin phototypes 4 and 5.
Limitations
The study was limited by its qualitative nature of accessing parameters as precise quantitative assessment of various findings cannot be done by a hand-held dermatoscope.
Conclusion
Nailfold capillaroscopy is a quick, cost-effective screening tool for identifying patients at high risk of DR in patients with skin of colour. NFC findings may mirror DR changes. The qualitative findings of NFC using a hand-held dermatoscope were comparable to other modes of nailfold capillaroscopy.
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Hassan I, Jeelani S, Bali K, Bashir Y. Diagnostic utility of nailfold capillaroscopy using hand-held dermoscope in systemic sclerosis. Indian Dermatol Online J 2023; 14:200-206. [PMID: 37089847 PMCID: PMC10115326 DOI: 10.4103/idoj.idoj_361_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 11/12/2022] [Accepted: 11/14/2022] [Indexed: 03/12/2023] Open
Abstract
Introduction The pathogenesis in systemic sclerosis (SSc) mainly involves vascular injury, fibrosis, and immune activation. Visualization of these microvascular changes by nailfold capillaroscopy (NFC) can help in the early diagnosis of the disease. Even though the gold standard for NFC is a videodermoscope, the ease, practicality, and accessibility make the hand-held dermoscope a more versatile and suitable device in the hands of the dermatologists in the busy outpatient department. Aim To study the pattern of nail fold capillaries using hand-held dermoscope in the patients of SSc and correlate the findings with disease severity. Materials and Methods An observational, cross-sectional hospital-based study was carried out over a span of 2 years, from January 2020 till December 2021, in 50 patients of SSc. NFC using DermLite DL4 was performed in all the patients and distribution, morphology, density of capillaries, and nail fold capillary pattern were observed. Results Out of 50 patients, 38 patients had diffuse type of disease, and 12 had limited type of disease. The mean capillary density in our patients was 4.7 ± 0.81/mm. Dilated capillaries was the most common NFC finding (80%), whereas active scleroderma pattern was the most common pattern (56%). A significant association was found between the type of capillary pattern and duration of disease, type of disease, and cutaneous manifestations. Conclusion Hand-held dermoscope is reliable, practical, and assessable tool that aids in early diagnosis of the disease and also helps in assessing the severity and prognosis of SSc.
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Suma KV, Dinesh PA, Rao B. Multivariate Parametric Study of Nailfold Capillary Images for Disease Detection. Crit Rev Biomed Eng 2023; 51:1-19. [PMID: 37560877 DOI: 10.1615/critrevbiomedeng.2023047066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Abstract
Nailfold capillaroscopy is a tool which is non-invasive in nature and can be useful for diagnosis, research, therapeutic study and prognosis. Research shows that specific capillary morphology patterns are identified for diabetic subjects, hypertensive subjects and normal controls. In this study, we have proposed RATHEW approach of classifying these three classes of subjects. RATHEW approach employs a three step process for classifying nailfold images: one, identify six abnormality parameters from the image dataset; two, score these abnormality parameters based on the defined scoring rules; and three, combine them mathematically to segregate them into three classes. This technique can be further enhanced to grade the severity of disease and organ involvement. This can bring in a paradigm shift to the disease detection and therapeutic study mechanism.
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Affiliation(s)
- K V Suma
- Department of Electronics and Communication, M S Ramaiah Institute of Technology, Bangalore, Karnataka 560054, India
| | - P A Dinesh
- Department of Mathematics, Ramaiah Institute of Technology, MSRIT Nagar, Bangalore 560 054, India
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Lyu S, Chen Z, Cui M, Wei Q, Li Y, Fang H, Liu M, Liu L, Fu J, Zhang J. Effectiveness of an online/offline mixed-mode Tai Chi cardiac rehabilitation program on microcirculation in patients with coronary artery disease: A randomized controlled study. Clin Hemorheol Microcirc 2023; 85:385-393. [PMID: 37781795 DOI: 10.3233/ch-231894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
OBJECTIVE We explored the effectiveness of an online/offline mixed-mode Tai Chi cardiac rehabilitation program on the microcirculation of patients with coronary artery disease (CAD). DESIGN Prospective, randomized controlled study. SETTING It was conducted in a tertiary hospital. SUBJECTS Twenty-six patients who met the diagnostic criteria for coronary artery disease were recruited. INTERVENTIONS Patients were randomized divided into a 12-week Tai Chi cardiac rehabilitation program(TCCRP) or a conventional exercise rehabilitation program(CERP) in a 1:1 fashion, 4 weeks of in-hospital rehabilitation and 8 weeks of online rehabilitation at home (a total of 12 weeks of intervention). MAIN OUTCOME MEASURES Nailfold microcirculation (Morphological integrals, Blood flow integrals, Periphery capillary loop integrals, Overall integrals). MAIN OUTCOME MEASURES Twenty patients completed the study. The Morphological integrals (baseline: 2.875±1.171 vs 12weeks: 1.863±0.414, t = 2.432, P = 0.045 < 0.05) and Overall integrals (baseline: 5.563±2.001 vs 12weeks: 3.688±1.167, t = 3.358, P = 0.012 < 0.05) decreased significantly in the TCCRP, The nailfold microcirculation integra decreased not significantly in the CERP (P > 0.05). The nailfold microcirculation integra was not significantly different between the two groups after the intervention (P > 0.05). CONCLUSIONS The TCCRP improved the microcirculation of patients with CAD.
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Affiliation(s)
- Shaojun Lyu
- College of P.E. and Sports, Beijing Normal University, Beijing, China
| | - Zaihao Chen
- College of P.E. and Sports, Beijing Normal University, Beijing, China
| | - Meize Cui
- College of P.E. and Sports, Beijing Normal University, Beijing, China
| | - Qiuyang Wei
- Sports Department of Jiangsu University, Zhenjiang, Jiangsu, China
| | - Yameng Li
- College of P.E. and Sports, Beijing Normal University, Beijing, China
| | - Hui Fang
- College of P.E. and Sports, Beijing Normal University, Beijing, China
| | - Mingyu Liu
- College of P.E. and Sports, Beijing Normal University, Beijing, China
| | - Linli Liu
- College of P.E. and Sports, Beijing Normal University, Beijing, China
| | - Jiahao Fu
- College of P.E. and Sports, Beijing Normal University, Beijing, China
| | - Jianwei Zhang
- College of P.E. and Sports, Beijing Normal University, Beijing, China
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