Dermatoscopic Assessment of Nail Fold Capillary Patterns in Patients of Color with Different Autoimmune Connective Tissue Diseases

Introduction: Nail fold capillaroscopy is a noninvasive tool for assessing early capillary changes in proximal nail fold capillaries in autoimmune connective tissue diseases. Handheld dermatoscopes have expanded its clinical application. Objectives: To characterize nail fold capillary patterns using dermatoscopy and evaluate their association with autoimmune connective tissue disease severity in patients with skin of color (Fitzpatrick skin types IV, V and VI). Methods: A six-month cross-sectional study was conducted at Ghurki Trust Teaching Hospital in Lahore, Pakistan. Ninety-six patients with Fitzpatrick skin types IV-VI and autoimmune connective tissue diseases underwent dermatoscopic evaluation (HEINE DELTA 30 Dermatoscope) and clinical assessment of disease activity. Results: Most participants were female (84.4%). The diagnoses included rheumatoid arthritis (RA) (51%), systemic lupus erythematosus (SLE) (27%), systemic scleroderma (SSc) (17%), and dermatomyositis (DM) (5%). Capillary patterns varied significantly with disease duration (p = 0.001) and diagnosis. Normal patterns were observed in 27 patients (28.1%), nonspecific patterns in 28 patients (29.2%), and scleroderma patterns in 41 patients (42.7%). Scleroderma patterns were most frequent in those with SSC and SLE. Focal microhemorrhages (52.1%) and areas of discrete devascularization (50%) were the most prevalent microvascular findings. Capillary patterns were significantly associated with disease severity (p < 0.001). Conclusions: Dermatoscopic assessment of nail fold capillaries may provide a valuable, noninvasive biomarker of disease activity in autoimmune connective tissue diseases. This study provides valuable data on skin of color, which remains underrepresented in dermatological research.