Department of Dermatology, Habib Thameur Hospital, Tunis, Tunisia.
Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia.
Int J Dermatol. 2024 Jul;63(7):942-946. doi: 10.1111/ijd.17113. Epub 2024 Mar 1.
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.
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).
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.
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.
结缔组织疾病（CTD）中的指甲变化评估在以前的研究中很少被探讨。使用皮肤镜研究甲襞的血管变化是一种有趣的诊断技术。本研究的目的是描述 CTD 中指甲病变的流行病学、临床和皮肤镜特征。
一项前瞻性研究于 2020 年 7 月至 2021 年 9 月在突尼斯的哈比卜·塔梅尔医院皮肤科（突尼斯突尼斯市）与内科合作进行，包括诊断为系统性硬化症（SS）、系统性红斑狼疮（SLE）和皮肌炎（DM）的患者。
我们的研究包括 48 例患者。44 例存在指甲受累。37 例指甲甲襞异常。最常见的临床特征是参差不齐的甲小皮、甲襞红斑和甲分离。此外，还描述了裂片出血、纵向脊、半月异常、甲黑素、糙皮病、白甲、横曲度增加、鹦鹉嘴甲、半甲和甲纵裂。指甲甲襞皮肤镜显示正常模式 10 例、非特异性模式 9 例（SLE）和硬皮病模式 29 例（SS 和 DM）。硬皮病模式进一步分为早期模式（6）、活跃模式（14）和晚期模式（9）。仅在缓解期的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，疾病活动与甲分离、甲襞红斑和皮肤镜下的病理模式相关。然而，DM 患者的肺部受累与硬皮病模式呈正相关。
CTD 中的指甲受累包括多种异常。尽管它是非特异性的，但它可以为建立诊断提供重要线索。指甲甲襞皮肤镜检查是微血管病变的一面镜子，能够在早期发现变化，因此成为一种诊断和预后工具。
