Nailfold dermoscopy predicts the absence of a capillaroscopy sclerodermic pattern: The multicentre, prospective VASCUL-R trial.
Journal
Journal of the European Academy of Dermatology and Venereology : JEADV
ISSN: 1468-3083
Titre abrégé: J Eur Acad Dermatol Venereol
Pays: England
ID NLM: 9216037
Informations de publication
Date de publication:
22 Jan 2024
22 Jan 2024
Historique:
received:
15
03
2023
accepted:
28
11
2023
medline:
22
1
2024
pubmed:
22
1
2024
entrez:
22
1
2024
Statut:
aheadofprint
Résumé
Nailfold capillaroscopy is recommended to diagnose primary or secondary Raynaud's phenomenon (RP). Capillaroscopy is normal in primary RP, which is the most frequent. Screening for RP capillary anomalies with nailfold dermoscopy has been promising. To determine whether normal nailfold dermoscopy-based on the absence of five criteria that define a sclerodermic pattern-is able to predict normal capillaroscopy with good positive-predictive value (PPV). Prospective, 2-phase (monocentre and multicentre) study on patients at first consultation for RP undergoing nailfold video capillaroscopy (NVC) and nailfold dermoscopy by two different 'blinded' trained observers, respectively, a vascular specialist and a dermatologist, not familiar with capillaroscopy. The five criteria noted were as follows: disorganization, megacapillaries, low capillary density, avascular areas and haemorrhages. Based on 105 patients, the dermoscopy PPV for a normal NVC was 100% (p = 0.015), with 37.9% sensitivity, when no criterion was observed. Excluding haemorrhages, the PPV remained 100% (p < 0.0001), with sensitivity rising to 73.7% and 100% specificity. Normal nailfold dermoscopy with the absence of four easy-to-observe criteria predicts normal NVC with an excellent PPV.
Sections du résumé
BACKGROUND
BACKGROUND
Nailfold capillaroscopy is recommended to diagnose primary or secondary Raynaud's phenomenon (RP). Capillaroscopy is normal in primary RP, which is the most frequent. Screening for RP capillary anomalies with nailfold dermoscopy has been promising.
OBJECTIVE
OBJECTIVE
To determine whether normal nailfold dermoscopy-based on the absence of five criteria that define a sclerodermic pattern-is able to predict normal capillaroscopy with good positive-predictive value (PPV).
METHODS
METHODS
Prospective, 2-phase (monocentre and multicentre) study on patients at first consultation for RP undergoing nailfold video capillaroscopy (NVC) and nailfold dermoscopy by two different 'blinded' trained observers, respectively, a vascular specialist and a dermatologist, not familiar with capillaroscopy. The five criteria noted were as follows: disorganization, megacapillaries, low capillary density, avascular areas and haemorrhages.
RESULTS
RESULTS
Based on 105 patients, the dermoscopy PPV for a normal NVC was 100% (p = 0.015), with 37.9% sensitivity, when no criterion was observed. Excluding haemorrhages, the PPV remained 100% (p < 0.0001), with sensitivity rising to 73.7% and 100% specificity.
CONCLUSION
CONCLUSIONS
Normal nailfold dermoscopy with the absence of four easy-to-observe criteria predicts normal NVC with an excellent PPV.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Société Française de Dermatologie et de Pathologie Sexuellement Transmissible
Informations de copyright
© 2024 European Academy of Dermatology and Venereology.
Références
Garner R, Kumari R, Lanyon P, Doherty M, Zhang W. Prevalence, risk factors and associations of primary Raynaud's phenomenon: systematic review and meta-analysis of observational studies. BMJ Open. 2015;5(3):e006389.
Maverakis E, Patel F, Kronenberg DG, Chung L, Fiorentino D, Allanore Y, et al. International consensus criteria for the diagnosis of Raynaud's phenomenon. J Autoimmun. 2014;48-49(3):60-65.
Koenig M, Joyal F, Fritzler MJ, Roussin A, Abrahamowicz M, Boire G, et al. Autoantibodies and microvascular damage are independent predictive factors for the progression of Raynaud's phenomenon to systemic sclerosis: a twenty-year prospective study of 586 patients, with validation of proposed criteria for early systemic sclerosis. Arthritis Rheum. 2008;58(12):3902-3912.
Overbury R, Murtaugh MA, Fischer A, Frech TM. Primary care assessment of capillaroscopy abnormalities in patients with Raynaud's phenomenon. Clin Rheumatol. 2015;34(12):2135-2140.
Sontheimer RD. A portable digital microphotography unit for rapid documentation of periungual nailfold capillary changes in autoimmune connective tissue diseases. J Rheumatol. 2004;31(3):539-544.
Park JH, Lee DY, Cha HS, Koh EM. Handheld portable digital dermoscopy: routine outpatient use for evaluating nail-fold capillary changes in autoimmune connective tissue diseases. J Eur Acad Dermatol Venereol. 2009;23(2):207.
Muroi E, Hara T, Yanaba K, Ogawa F, Yoshizaki A, Takenaka M, et al. A portable dermatoscope for easy, rapid examination of periungual nailfold capillary changes in patients with systemic sclerosis. Rheumatol Int. 2011;31(12):1601-1606.
Chojer P, Mahajan BB. Nail fold dermoscopy in collagen vascular disorders: a cross-sectional study. Indian J Dermatol Venereol Leprol. 2019;85(4):439-446.
Chanprapaph K, Fakprapai W, Limtong P, Suchonwanit P. Nailfold capillaroscopy with USB digital microscopy in connective tissue diseases: a comparative study of 245 patients and healthy controls. Front Med. 2021;8:683900.
Bhakuni DS, Vasdev V, Garg MK, Narayanan K, Jain R, Mullick G. Nailfold capillaroscopy by digital microscope in an Indian population with systemic sclerosis. Int J Rheum Dis. 2012;15(1):95-101.
Beltrán E, Toll A, Pros A, Carbonell J, Pujol RM. Assessment of nailfold capillaroscopy by × 30 digital epiluminescence (dermoscopy) in patients with Raynaud phenomenon. Br J Dermatol. 2007;156(5):892-898.
Boulon C, Devos S, Mangin M, Decamps-Le Chevoir J, Senet P, Lazareth I, et al. Reproducibility of capillaroscopic classifications of systemic sclerosis: results from the SCLEROCAP study. Rheumatology. 2017;56(10):1713-1720.
Shenavandeh S, Ajri M, Hamidi S. Causes of Raynaud's phenomenon and the predictive laboratory and capillaroscopy features for the evolution to a definite connective tissue disease. Rheumatology. 2022;61(5):1975-1985.
Radic M, Snow M, Frech TM, Saketkoo LA, Cutolo M, Smith V. Consensus-based evaluation of dermatoscopy versus nailfold videocapillaroscopy in Raynaud's phenomenon linking USA and Europe: a European League against Rheumatism Study Group on microcirculation in rheumatic diseases project. Clin Exp Rheumatol. 2020;38(3):S132-S136.
Dinsdale G, Peytrignet S, Moore T, Berks M, Robert C, Manning J, et al. The assessment of nailfold capillaries: comparison of dermoscopy and nailfold videocapillaroscopy. Rheumatology. 2018;57(6):1115-1116.
Hughes M, Moore T, O'Leary N, Tracey A, Ennis H, Dinsdale G, et al. A study comparing videocapillaroscopy and dermoscopy in the assessment of nailfold capillaries in patients with systemic sclerosis-spectrum disorders. Rheumatology. 2015;54(8):1435-1442.
Mazzotti NG, Bredemeier M, Brenol CV, Xavier RM, Cestari TF. Assessment of nailfold capillaroscopy in systemic sclerosis by different optical magnification methods. Clin Exp Dermatol. 2014;39(2):135-141.
Arana-Ruiz JC, Silveira LH, Castillo-Martínez D, Amezcua-Guerra LM. Assessment of nailfold capillaries with a handheld dermatoscope may discriminate the extent of organ involvement in patients with systemic sclerosis. Clin Rheumatol. 2016;35(2):479-482.
Pizzorni C, Giampetruzzi AR, Mondino C, Facchiano A, Abeni D, Paolino S, et al. Nailfold capillaroscopic parameters and skin telangiectasia patterns in patients with systemic sclerosis. Microvasc Res. 2017;111(5):20-24.
Ohtsuka T. Dermoscopic detection of nail fold capillary abnormality in patients with systemic sclerosis. J Dermatol. 2012;39(4):331-335.
Siqueira VS, Helbingen MFS, Medeiros-Ribeiro AC, Carriço da Silva H, Miossi R, Luppino-Assad AP, et al. Predictors of progression to systemic sclerosis: analysis of very early diagnosis of systemic sclerosis in a large single-centre cohort. Rheumatology. 2022;61(9):3686-3692.
Bauersachs RM, Lössner F. The poor man's capillary microscope. A novel technique for the assessment of capillary morphology. Ann Rheum Dis. 1997;56(7):435-437.