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      Nailfold Capillaroscopy of Healthy Individuals – An Observational Study

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          Abstract

          Background:

          Nailfold capillaroscopy (NFC) is a noninvasive quick method to visualize capillaries in the nailfold. There is paucity of these studies in healthy individuals in skin of color.

          Aim:

          To evaluate the morphological characteristics and density of nailfold capillaries in healthy individuals.

          Settings and Design:

          This observational cross-sectional study was conducted in the Department of Dermatology at a tertiary care hospital. About 150 healthy individuals by consecutive sampling were included in the study.

          Materials and Methods:

          A total of 150 healthy individuals aged between 20 and 60 years were enrolled from January 2021 to September 2021 after consenting to the study protocol and qualifying the inclusion and exclusion criteria. NFC was performed for various morphological parameters and mean capillary density was also calculated. Comparison was done in male vs female, age group 20–40 vs 41–60, and body mass index (BMI) <24.9 vs >25.

          Statistical Analysis:

          Different morphological parameters and capillary density were recorded and analyzed. The Mann–Whitney and Pearson’s chi square was used according to type of data.

          Results:

          The study observed tortuous capillaries (45.33%), meandering capillaries (44.66%), neoangiogenesis (38.66%), plexus visibility (36.66%), dilated capillaries (33.33%), receding capillaries (31.33%), angulated capillaries (14.66%), and ramified capillaries (6.6%). The study found significantly decreased plexus visibility in those with BMI > 25.Tortuous and receding capillaries were significantly increased in age group >40 years.

          Conclusion:

          Various capillary morphological findings can be present in normal individuals but their presence in more number of fingers should be considered to be pathological. This data on normal morphology and capillary density add to the physiological NFC findings and thus aid in identifying the abnormalities.

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          Most cited references14

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          The cutaneous microcirculation.

          The cutaneous microcirculation is organized as two horizontal plexuses. One is situated 1-1.5 mm below the skin surface and the other is at the dermal-subcutaneous junction. Ascending arterioles and descending venules are paired as they connect the two plexuses. From the upper layer, arterial capillaries rise to form the dermal papillary loops that represent the nutritive component of the skin circulation. There are sphincter-like smooth muscle cells at the point where the ascending arterioles divide to form the arteriolar component of the upper horizontal plexus. At the dermal-subcutaneous junction, there are collecting veins with two cusped valves that are oriented to prevent the retrograde flow of blood. Laser Doppler flowmetry has demonstrated vasomotion of red cell flux localized to the sites of ascending arterioles. The simultaneous recording by laser Doppler flowmetry of red cell flux and the concentration of moving red blood cells from individual sites allows one to construct topographic maps of these two values. These two maps, based on initial studies using correlative skin biopsies, can define 1 mm3 volumes of skin that are predominantly arteriolar in composition, venular in composition, or essentially devoid of all microvascular elements. The electron and light microscopic features that define the microvascular segments, when coupled with that ability of laser Doppler flowmetry to define the predominant microvascular segments under the probe, allow one to study both the mechanisms of normal physiologic states and the pathogenetic mechanisms underlying pathologic skin disorders in which the microvasculature plays a predominant role.
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            Nailfold Capillaroscopy in Rheumatic Diseases: Which Parameters Should Be Evaluated?

            Video nailfold capillaroscopy (NFC), considered as an extension of the widefield technique, allows a more accurate measuring and storing of capillary data and a better defining, analyzing, and quantifying of capillary abnormalities. Capillaroscopic study is often performed on the patients suspected of having microcirculation problems such as Raynaud's phenomenon as the main indication for nailfold capillaroscopy. Capillaroscopic findings based on microcirculation studies can provide useful information in the fields of pathophysiology, differential diagnosis, and monitoring therapy. Nailfold capillaroscopy provides a vital assessment in clinical practices and research; for example, its reputation in the early diagnosis of systemic sclerosis is well established and it is also used as a classification criterion in this regard. This review focuses on the manner of performing video nailfold capillaroscopy and on a common approach for measuring capillary dimensions in fingers and toes.
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              How to perform and interpret capillaroscopy.

              The essence of capillaroscopy is to examine, noninvasively and safely the morphology of nailfold dermal papillary capillaries using a magnification system (microscopical lenses). Capillaroscopy may be performed with lenses with low (×20) and with high magnification (×200 up to ×600). The video-capillaroscope consists of an optical/digital probe which is moved to the finger of the patient and allows direct contact with the nailfold. Through qualitative assessment a normal capillaroscopy can be distinguished from a pathognomonic abnormal one due most frequently to systemic sclerosis (SSc). This pattern recognition relies on evaluating the morphology of the capillaries, their density (number) and dimensions 'at sight' of the capillaries and their architecture. In SSc three progressive capillaroscopic patterns have been described ('early', 'active' and 'late'). Quantitative assessment (quantitation of certain characteristics and semi-quantitative scoring) of the capillaroscopic pictures may also be performed. Qualitative and semi-quantitative assessments are used to predict SSc clinical complications. In other connective tissue diseases (CTDs) prospective clinical studies resulting in indices which can predict future clinical complications have not been published, as yet. Copyright © 2013 Elsevier Ltd. All rights reserved.
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                Author and article information

                Contributors
                Journal
                Indian Dermatol Online J
                Indian Dermatol Online J
                IDOJ
                Indian Dermatol Online J
                Indian Dermatology Online Journal
                Wolters Kluwer - Medknow (India )
                2229-5178
                2249-5673
                Sep-Oct 2022
                05 September 2022
                : 13
                : 5
                : 600-605
                Affiliations
                [1] Department of Dermatology Venereology and Leprosy, Government Medical College, Bhavnagar, Gujarat, India
                Author notes
                Address for correspondence: Dr.Amitkumar R. Gorasiya, 602, Pg-3 Hostel, Sir T Hospital Campus, Jail Road, Bhavnagar-364 001, Gujarat, India. E-mail: a.r.gorasiya@ 123456gmail.com
                Article
                IDOJ-13-600
                10.4103/idoj.idoj_80_22
                9595142
                36304665
                bf390339-2f33-4fa7-b77a-8da39118b65a
                Copyright: © 2022 Indian Dermatology Online Journal

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                : 07 February 2021
                : 07 June 2022
                : 08 June 2022
                Categories
                Original Article

                Dermatology
                capillary density,morphological characteristics,nailfold capillaroscopy,proximal nailfold

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