Nailfold Capillaroscopy in Psoriatic Patients with Metabolic Syndrome: A Comparative Observational Study

Objectives: Psoriasis, a systemic disorder, is linked with metabolic comorbidities. Nailfold capillaroscopy (NFC), a non-invasive technique, is utilised to evaluate microcirculation in the nailfold area. This study aimed at assessing nailfold capillary changes among psoriatic patients with metabolic syndrome (MeS) and compared these finding to those of healthy controls. Materials and Methods: An evaluation of 75 patients with psoriasis and 75 age- and sex-matched healthy controls were done. NFC was performed using universal serial bus videodermatoscope on the 4 th and 5 th digits of both hand and MeS was diagnosed using National Cholesterol Education Program and Adult Treatment Panel III criteria. Results: Twenty-five (33%) psoriatic patients and 10 (13.3%) healthy control had MeS ( P = 0.004). The mean nailfold capillary density in psoriasis patients with and without MeS was significantly less than that in healthy controls (P < 0.005 and <0.001, respectively). Dilated, bushy and dropout capillaries were significantly higher in Psoriatic patients with MeS; whereas, meandering, dilated, giant, bushy, bizarre capillaries, microhaemorrhages, dropouts and avascular areas were significantly higher in psoriatic patients without MeS when compared to respective groups of healthy control with MeS or without MeS. Conclusion: Decreased mean capillary density and higher incidence of budding and bushy capillaries in psoriatic patients with MeS as compared to psoriatic patients without MeS points toward a pathogenic role of MeS in microvascular damage; however, the absence of an association with disease duration and severity suggests that these capillary changes might serve as early markers of MeS, which warrants further investigation in larger and prospective studies.