Capillaroscopic Pattern at the Toes of Systemic Sclerosis Patients Does It Tell More Than Those of Fingers?

Purpose: The aim of the study was to compare nail fold capillaroscopic findings of the fingers with those of the toes in patients with systemic sclerosis (SSc). Methods: Thirty-six patients with SSc were included in the study: 30 patients had limited SSc, 5 patients had diffuse SSc, and 1 patient had an overlap syndrome. Of these 36 patients, 30 were women and 6 were men (mean [SD] age, 56 [14] years). The severity of the Raynaud phenomenon (RP), the presence of digital ulcers, and skin scores at the fingers and feet were assessed. Nail fold capillaroscopy was performed with a videocapillaroscope (Videocap 3.0; DS Medica). Results: All 36 patients (100%) reported about symptoms of RP in the hands and 34 (94.4%) reported episodes of RP in the feet; the difference is not significant (P > 0.05). In most patients with RP symptoms of both hands and feet, the symptoms were more severe at the hands (82%, 28/34). Digital ulcers of the fingers were found in 36% (13/36) of the case and those of the toes were found in 8.3% (3/36) of the cases. Nail fold capillaroscopy of the hands showed the classic scleroderma-type capillaroscopic pattern in 97.2% (35/36) of the patients. In the toes, a scleroderma-type capillaroscopic pattern was found only in 66.7% (24/36) of patients (P < 0.05). With respect to distinct differences, in the toes, the dilated capillaries were found in 72.2% (26/36) of the cases, giant capillaries in 30.6% (11/36) of the cases, hemorrhages in 8.3% (3/36) of the cases, avascular areas in 41.7% (15/36) of the cases, and neoangiogenesis in 22.1% (8/36) of the cases. This difference in frequency of the findings regarding the toes and the fingers of patients with SSc was statistically significant for all parameters. Conclusions: Capillaroscopy of the toes of SSc also shows patterns characteristic of SSc. However, these patterns differ from the respective patterns of the fingers, which is probably related to less-severe RP and lower skin score at the feet.