An Observational Case Control Study of Nailfold Capillary Dermoscopy in a Sample of Iraqi Patients with Connective Tissue Diseases: A Single Center Study

  • Hayder R.M Al-Hamamy, Faiq I. Gorial, Dalya Mohammed Attrah
Keywords: Nailfold capillaroscopy, connective tissue diseases, Raynaud’s, scleroderma, dermatomyositis, and systemic lupus erythematosus.





Connective tissue diseases show certain characteristic morphological changes in their nailfold capillaries. Studies are limited on nailfold capilloroscopic findings using dermoscopy.


To describe nailfold capillary findings and patterns in patients with connective tissue diseases using dermoscopy.


Demographic variables, nailfold capillary findings and patterns were examined and described using a handheld dermoscope in 40 healthy control subjects and 85 patients with connective tissue diseases including 37 scleroderma patients, 36 systemic lupus erythematosus and 12 dermatomyositis patients.


Capillary disorganization, giant capillaries, capillary hemorrhage, avascular areas and ramified capillaries were significantly higher in patients than control subjects (p<0.001). Giant capillaries, hemorrhages, avascular areas, disorganized and ramified capillaries were observed significantly more in scleroderma and dermatomyositis patients than systemic lupus erythematosus patients, but no single finding differentiated scleroderma from dermatomyositis. The presence of tortuous capillaries was significantly more in systemic lupus erythematosus patients than scleroderma and dermatomyositis (p<0.001). The scleroderma-dermatomyositis pattern is observed significantly higher in patients than controls (p<0.001). The scleroderma-dermatomyositis pattern was seen significantly more in dermatomyositis and scleroderma than in patients with systemic lupus (100% and 86.5% respectively vs. 11.1%, p<0.001). The normal pattern was significantly more seen in systemic lupus than scleroderma and dermatomyosits (66.7% vs 5.4% and 0% respectively, p<0.001).


The dermoscope is a very useful tool in detecting scleroderma- dermatomyositis pattern, allowing a confident differentiation among normal subjects and those with underlying connective tissue diseases. The scleroderma-dermatomyositis pattern is seen in scleroderma as well as in dermatomyositis but to a much lesser extent in systemic lupus erythematosus patients. Detecting a normal pattern in a patient with underlying connective tissue disease is more likely to be seen in systemic lupus erythematosus patients rather than other diagnoses.