Abstract
Nailfold capillaroscopy is a simple, non-invasive and low-cost method, that is extremely important in the assessment of adults and children with definite or suspected connective tissue diseases. Peripheral microvascular changes found in nailfold capillaroscopy examination can provide useful information in differential diagnosis and therapy monitoring in majority of connective tissue diseases. Although in adult rheumatology this method has had an incredibly growing interest in the last decades, studies in paediatric population are fewer and generally, the capillaroscopic data used in children are extrapolated from adults. The normal capillaroscopic pattern in the paediatric population has some differences which must be known when performing nailfold capillaroscopy in children.
Highlights
INTRODUCTIONNailfold capillaroscopy (NFC) is a non-invasive and extremely valuable method used for the study of microcirculation, with clinical applications in the assessment of adults as well as children with definite or suspected connective tissue diseases (CTDs) [1,2,3,4,5,6,7,8,9,10,11,12,13]
The main indication for nailfold capillaroscopy is Raynaud’s phenomenon, but in children this condition is rare, and the main indications are represented by connective tissue diseases (CTDs), especially juvenile systemic sclerosis and juvenile dermatomyositis (JDM) [14,15,16,17,18,19,20,21]
The normal appearance of nailfold capillaries in children is similar to adults, the differences being represented by a lower number of capillary loops per millimetre, wider capillaries in young children, a greater visibility of the subpapillary venous plexus and a higher frequency of atypical capillary loops
Summary
Nailfold capillaroscopy (NFC) is a non-invasive and extremely valuable method used for the study of microcirculation, with clinical applications in the assessment of adults as well as children with definite or suspected connective tissue diseases (CTDs) [1,2,3,4,5,6,7,8,9,10,11,12,13]. Regardless of the patients’ age, adults or children, during the examination of nailfold capillaries the following aspects are observed and documented: skin transparency – subpapillary venous plexus; capillary distribution, density, dimensions (width and length), and shape (typical hairpin, tortuous, branched, bushy, dilated or giant capillaries); presence of haemorrhages or oedema and sometimes capillary blood flow [22,23,24]. In children as in adults, a normal nailfold capillaroscopic pattern is represented by a parallel and regular disposition of the distal row, capillaries having with the shape of an open hairpin or reversed U letter, with a thinner arm representing the arterial branch and a thicker arm representing the venous branch, and a density of 7-17 per millimetre, with an average of 9 capillary per millimetre [6,7,9,12,15,22,23,24]. The main particularities in children are represented by a greater visibility of the subpapillary venous plexus, a lower number of capillary loops per millimetre and a higher frequency of atypical capillary loops [10,12,13,25]
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