Single centred prospective controlled study on nail fold capillaroscopy and correlation with nail microvessel density in psoriatic patients in central India

Background: Psoriasis involves vasculature in the very early stages of the disease leading to impaired capillary permeability, decreased density of capillaries and loss of adhesion between endothelial cell and the matrix of papillary dermis. It is hypothesized that early endothelial dysfunction can be detected at the level of dermal capillary microvasculature. If these changes can be detected and quantified early they would help in the early diagnosis of psoriasis, course of the disease and response to the treatment. Methods: Single centred prospective controlled study was conducted on 100 patients with psoriasis attending the outpatient department of dermatology between March 2021 and August 2022. Inclusion criteria involved patients above 10 years of age and less than 80 years of age with moderate to severe psoriasis with or without psoriatic arthritis and PASI≥10 or BSA >10% and off systemic treatment for a minimum of 4 weeks. Controls were selected from individuals who had never been diagnosed with psoriasis. Data recorded was statistically analysed by using Chi-square (for ordinal data) or by t-test (for continuous data) and by non-parametric test. A p value<0.05 was considered as statistically significant for this purpose. Results: The mean age of cases was 39.00 ± 13.93 years and mean age of the control group was 40.31 ± 17.40. Most of the patients affected with psoriasis were in the age group of 30-60 years with a male predominance (M:F -1.5:1). 5% of the cases had bizarre morphology with a relatively lower MCD 6.6/mm than in the controls 8.41/mm. 20.0% and 17% of the cases had dilated Capillaries, tortuous capillaries respectively, while 13% and 11% cases showed haemorrhages and avascular areas respectively. Micro vessel density of psoriatic plaques quantified by IHC showed no significant correlation with any of the capillaroscopic findings. Conclusion: Evidences gathered support the role of NVC in the assessment of peripheral microcirculatory changes associated with systemic diseases. They provide a window for the visualisation of dermal capillaries, their morphological alterations and structural abnormalities, along with real time assessment of their functional dynamics.