Cutaneous Profile and Nail Fold Dermoscopy in Patients with Scleroderma

Abstract Introduction: Scleroderma is a chronic autoimmune connective tissue disorder characterized by skin thickening, vascular abnormalities, and multiorgan involvement. Cutaneous manifestations often provide early diagnostic clues, and nail fold capillaroscopy is an important non-invasive tool to assess microvascular changes and disease activity. Methods: This cross-sectional observational study was conducted over a period of one year at the Calcutta School of Tropical Medicine. A total of 80 patients diagnosed with systemic sclerosis (SSc) were enrolled. Data were collected on demographic variables including age and gender, disease-related factors such as disease duration and SSc subtype, as well as clinical characteristics including cutaneous features. Detailed dermoscopy and nailfold examinations were performed, and capillaroscopy patterns were documented. All variables were systematically recorded to assess their association with disease manifestations and nailfold capillaroscopic findings. Results: In this study of 80 systemic sclerosis patients (mean age 42.6 ± 11.3 years; 65% female), 62.5% had limited cutaneous SSc and 37.5% had diffuse cutaneous SSc. All patients exhibited skin thickening, with Raynaud’s phenomenon (87.5%) and telangiectasia (60%) as common manifestations, while digital ulcers were the least frequent (27.5%). Nailfold capillaroscopy patterns differed by subtype: limited SSc predominantly showed active patterns (40%), whereas diffuse SSc frequently exhibited late patterns (40%), with a statistically significant difference in the late pattern between subtypes (p = 0.002). Capillary density <7/mm correlated negatively with disease duration (r = -0.42, p = 0.001), and giant capillaries correlated positively (r = 0.36, p = 0.005). Microhemorrhages showed no significant correlation with disease duration. The presence of digital ulcers was strongly associated with capillaroscopic patterns, particularly the late pattern (p < 0.001). Conclusion: Cutaneous manifestations in scleroderma are diverse and provide important diagnostic and prognostic information. Nail fold dermoscopy is a valuable, non-invasive tool for detecting microvascular changes and assessing disease severity, particularly in differentiating diffuse from limited scleroderma and monitoring disease progression. Early recognition of dermoscopic abnormalities can aid in timely management and potentially improve outcomes.