Nail Fold Capillaroscopy for Diagnosis of Onychodystrophies: A Prospective Cross-Sectional Study

J Am Acad Dermatol. 2024 Aug 31:S0190-9622(24)02759-2. doi: 10.1016/j.jaad.2024.08.051. Online ahead of print.

ABSTRACT

BACKGROUND: Nail diseases are often associated with significant physical and psychosocial burden, but diagnosis is challenging due to non-specific clinical and histological findings. Nail fold capillaroscopy has been studied for diagnosis of systemic diseases, but studies on nail diseases are lacking.

OBJECTIVE: Our objectives were to characterize and compare capillary changes in a set of nail conditions vs. controls, between nail groups, and based on demographic/clinical criteria.

METHODS: This was a prospective cross-sectional study of patients with nail psoriasis, onychomycosis, idiopathic onycholysis, brittle nail syndrome, nail lichen planus, retronychia, other nail conditions, and no nail findings (controls) undergoing capillaroscopy imaging/analysis.

RESULTS: Nail psoriasis vs. control patients demonstrated decreased capillary length/density and increased abnormal capillaries, with higher frequency in older, male patients. Onychomycosis was associated with increased meandering capillaries compared to controls, nail psoriasis, and nail lichen planus. Retronychia is associated with increased disorganized polymorphic capillaries compared to controls and onychomycosis.

LIMITATIONS: Limitations include small sample size for certain nail conditions and small numbers of nail psoriasis patient with psoriatic arthritis.

CONCLUSION: Our findings highlight nailfold capillaroscopy as a potentially quick, cost-effective, and non-invasive imaging modality, as an adjunct for diagnosis and treatment initiation for patients with onychodystrophies.

PMID:39222880 | DOI:10.1016/j.jaad.2024.08.051