ABSTRACT
Background: Androgenetic alopecia is considered to be an independent predictor of mortality from diabetes mellitus and heart disease. However, whether androgenetic alopecia causes changes in microcirculation is unknown. Objective: The objective of the study was to investigate whether alterations in nailfold capillaries occur in androgenetic alopecia patients. Methods: The nailfold capillaroscopy images of androgenetic alopecia patients and matched controls were collected and analyzed. Results: The frequencies of avascular areas, dilated, bushy and bizarre capillaries and capillary disorganization, nailfold capillaroscopy scores of 2 or scores both 2 and 3 were significantly higher in the androgenetic alopecia group than in the healthy controls (9.0% vs. 0%, 57.7% vs. 19.2%, 3.8% vs. 0%, 2.8% vs. 1.3%, 3.8% vs. 0%, 38.5% vs. 12.8% and 39.7% vs. 12.8%, respectively). Limitations: The results of this study may be biased on account of the limited sample size or the presence of an undiagnosed disease in participants which could alter the nailfold capillaries. Conclusion: Bushy, bizarre and dilated capillaries, capillary disorganization, avascular areas and nailfold capillaroscopy scores of 2 or 2 and 3 were more common in androgenetic alopecia patients than in healthy controls. These findings indicate that abnormalities in microcirculation may be involved in androgenetic alopecia
ABSTRACT
Leprosy is a chronic granulomatous infectious disease with a proven role of Mycobacterium leprae invasion into endothelial cells. Animal studies have shown evidence of involvement of vasa nervorum in the process of nerve invasion. Capillaries act as the mirror image of vascular involvement in any rheumatic disorder and holds good for leprosy also. Nailfold capillaroscopy (NFC) is a non-invasive, easily reproducible technique to study proximal nailfold capillaries. The aim of this study is to investigate morphological nailfold capillaroscopic alterations in patients with leprosy in its various forms and comparison with the normal individual. Total 20 Leprosy patients and 20 normal age and sex matched individuals recruited for nailfold capillaroscopic examination using video dermoscopye. Among 20 normal individuals, 3(15%) individuals showed tortuous capillaries and microhemorrhages each, 2(10%) showed meandering vessels, 1(5%) each showed megacapillaries, dilated/ectatic capillaries and bizarre vessels. Out of 20 leprosy patients, 11 (55%) patients showed bizarre and meandering capillaries, 10(50%) showed dilated vessels and avascular areas, 9(45%) showed capillary dropouts and neovascularisation, 8(40%) showed tortuous vessels, 6(30%) haemorrhages and 4 (20%) showed megacapillaries. Findings like avascular areas, capillary dropouts, haemorrhages were more noticed in lepromatous and borderline lepromatous leprosy, whereas early capillary abnormalities like dilated, meandering, bizarre vessels and neoangiogenesis were noticed more in borderline tuberculoid leprosy. However, statistical significant difference between clinical and dermoscopic observations was not seen in this study. Further studies with a large sample size are required to find out the same. Morphological changes may denote micro-vascular invasion by Mycobacterium leprae and may act as warning signs of fore- coming complications like loss of sensation and trophic ulcers. Follow-up studies are required to understand such correlation, if any.
ABSTRACT
La capilaroscopia del lecho ungueal (CLU) es un método simple, inocuo y económico para el estudio detallado de la microcirculación en una amplia gama de enfermedades o síndromes de interés reumatológico. En el fenómeno de Raynaud (FR) no solo permite un preciso estudio de la circulación capilar sino que facilita la distinción entre FR primario y secundario. Posee un excepcional valor predictivo en la individuación de anormalidades morfoestructurales en fases tempranas de la esclerosis sistémica (ES), lo cual representa una de las principales ventajas de este método de imagen. El daño microvascular es una típica característica de la esclerosis sistémica que viene representada por desorganización arquitectónica, presencia de tortuosidades, aumento del diámetro de los capilares, neoangiogénesis, hemorragias/trombosis y reducción de la densidad de los capilares. Tales cambios capilaroscópicos delinean el patrón esclerodérmico que a su vez es la máxima expresión de la microangiopatía esclerodérmica propiamente dicha. Anormalidades capilaroscópicas están también presentes en otras enfermedades reumáticas sistémicas como: dermatomiositis, síndrome de Sjögren, lupus eritematoso sistémico, enfermedad indiferenciada del tejido conectivo y síndrome antifosfolípido. Esta revisión tiene como objetivo remarcar las aplicaciones y los límites de la CLU y sus respectivas aplicaciones en la práctica cotidiana reumatológica.
Nailfold capillaroscopy is a simple, non-invasive, inexpensive and useful method for the analysis of microvascular abnormalities that can be found in rheumatic disorders. The well-known Raynauds phenomenon represents a clinical condition that should promptly lead to a microvascular analysis, in order to distinguish its primary form from the secondary. Capillaroscopy has an exceptional predictive value for the diagnosis of early systemic sclerosis and this may be the best advantage this technique can offer. Microvascular damage is a typical feature of systemic sclerosis and a great number of this patients present architectural disorganization, tortuositis, giant capillaries, neovascularization haemorrhages, loss of capIllaries and avascular areas. These capillaroscopic changes characterize the scleroderma pattern and reflect the scleroderma microangiopathy. Microvascular abnormalities have also been found in other systemic rheumatic diseases such as dermatomyositis, Sjögrens syndrome, systemic lupus erythematosus, undifferentiated connective tissue disease and antiphospholipid syndrome. The aim of this review is to describe the applications and limits of naifold capillaroscopy in the rheumatological clinical practice.