背景:在先前的研究中很少探索结缔组织疾病(CTD)中指甲变化的评估。使用皮肤镜检查研究指甲褶皱的血管变化是一种有趣的诊断技术。这项研究的目的是描述流行病学,临床,CTD中指甲病变的皮肤镜特征。
方法:在HabibThameur医院皮肤科进行了一项前瞻性研究(突尼斯,突尼斯)与内科部门合作,为期15个月,从2020年7月到2021年9月,包括诊断为系统性硬化症(SS)的患者,系统性红斑狼疮(SLE)和皮肌炎(DM)。
结果:我们的研究包括48例患者。在44例中发现了指甲参与。37例皮肤镜下甲皱异常。最常见的临床特征是角质层粗糙,甲褶红斑,和甲状腺溶解症。此外,裂片出血,纵向起皱,脑膜异常,黑甲癣,硬甲癣,白甲,横向曲率增加,鹦鹉喙指甲,一半和一半的指甲,和onychorrhexis被描述。10例甲皱皮肤镜检查显示正常,9例(SLE)的非特异性模式,硬皮病29例(SS和DM)。硬皮病模式进一步分为早期模式(6),活动模式(14),和晚期模式(9)。仅在缓解患者中观察到正常模式。晚期硬皮病模式与疾病持续时间和全身受累有关。在SLE中,疾病活动度与甲病相关,甲褶红斑,和皮肤镜检查的病理模式。然而,DM患者肺部受累与硬皮病呈正相关。
结论:指甲参与CTD包括多种异常。尽管是非特异性的,它可以为建立诊断提供关键线索。甲皱皮肤镜可以作为微血管病变的镜子,能够在初始阶段检测变化,因此,它成为诊断和预后的工具。
BACKGROUND: The assessment of nail changes in connective tissue diseases (CTD) has been rarely explored in previous studies. The use of dermoscopy to
study vascular changes in nailfolds is an interesting diagnostic technique. The aim of the
study was to describe the epidemiological, clinical, and dermoscopic features of nail lesions in CTD.
METHODS: A prospective
study was performed at the Dermatology Department of Habib Thameur Hospital (Tunis, Tunisia) in collaboration with the Internal Medicine Department over a period of 15 months, from July 2020 to September 2021, including patients diagnosed with systemic sclerosis (SS), systemic lupus erythematosus (SLE) and dermatomyositis (DM).
RESULTS: Our
study included 48 patients. Nail involvement was found in 44 cases. Dermoscopic nailfold abnormalities were identified in 37 cases. The most common clinical features were ragged cuticle, nailfold erythema, and onycholysis. Additionally, splinter hemorrhage, longitudinal ridging, lunula abnormalities, melanonychia, trachyonychia, leukonychia, increase in transverse curvature, parrot beak nail, half and half nails, and onychorrhexis were described. Nailfold dermoscopy showed a normal pattern in 10 cases, a nonspecific pattern in nine cases (SLE), and a scleroderma pattern in 29 cases (SS and DM). The scleroderma pattern was further categorized into an early pattern (6), an active pattern (14), and a late pattern (9). Normal pattern was observed solely in patients in remission. The late scleroderma pattern was associated with disease duration and systemic involvement. In SLE, disease activity correlated with onycholysis, nailfold erythema, and pathologic pattern in dermoscopy. However, patients with DM displayed a positive correlation between pulmonary involvement and scleroderma pattern.
CONCLUSIONS: Nail involvement in CTD includes a diverse range of abnormalities. Despite being nonspecific, it can provide crucial clues for establishing a diagnosis. Nailfold dermoscopy serves as a mirror for microangiopathy, enabling the detection of changes at an initial stage, and thus, it becomes a diagnostic and prognostic tool.