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Scleroderma Classification for Changes in Fingernail Capillaries

Purpose: To evaluate capillaries in the finger nailbed for changes seen in scleroderma based on the criteria of Maricq.

Description

Maricq described changes in the capillaries of the finger nailbed in patients with scleroderma that can be observed using widefield microscopy. This can help distinguish scleroderma from other connective tissue diseases. The author is from the Medical College of South Carolina.


Technique:

(1) Stereomicroscope with total magnification of 12 to 14 times.

(2) The light source should be cool and directed towards the skin at an angle of about 45 degrees.

(3) A drop of grade B immersion oil is placed on the nail being examined.

(4) The ability to take a picture of the finger nailbed is desirable for documentation.

 

SD (scleroderma) pattern:

(1) enlargement of capillary loops

(2) loss of capillaries

(3) disruption of the orderly appearance seen in the normal capillary bed

(4) distortion and "budding" of capillaries

 

Capillary hemorrhages may be seen in scleroderma but this is a nonspecific finding that can be seen in other connective tissue disorders.

 

SD Pattern

Capillary Loops in Nailfold

Capillary Loops in Other Finger Sites

Class

absent

NA

NA

I

present

enlarged

not enlarged

II

present

extremely enlarged

not enlarged

III

present

enlarged

enlarged

IV

present

extremely enlarged

extremely enlarged

V

 

Considerable finger-to-finger variation may be present.


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Specialty

Objective

ICD-10