Nail fold capillaroscopy: A diagnostic tool for early detection of microvascular complication in diabetics without retinopathy

Abstract

Background: Nailfold capillaroscopy is a major diagnostic tool for connective tissue disorders like systemic sclerosis. Microvascular complications in diabetes is the major cause of morbidity and mortality which if detected early can improve the quality of life of these patients. Materials and Methods: A prospective, cross-sectional study enrolled 30 diabetic patients for one year. An ophthalmologist examined all participants to rule out retinopathy. All patients subsequently underwent detailed nail fold capillaroscopy (NFC) examination of all ten fingernails with digital Dermatoscope. Data was recorded and presented with proportions. Results: The mean age was 45.88±11.49 years (p-value: 0.009) with 17 (56.1%) males and 13 (43.9%) females. Mean HbA1c was 7.1 (1.6) % (p-value: 0.074). One (1.3%) participant had abnormal nail plate, nail fold, and lunula on examination. In addition, 2 (6.7%) participants had abnormal (ragged) cuticles. The mean capillary density was 6.72±0.38 capillaries per mm (range 5.83-7.24). Tortuosity was the most common observed qualitative change (n=28; 93.3%) followed by meandering capillaries (n=23; 76.7%), capillary dilatation (n=15; 50.0%) and avascular areas (n=14; 46.7%). Conclusion: In diabetic patients without retinopathy, nail fold changes appear before microangiopathic complications like retinopathy. Nailfold capillaroscopy is a potential early screening tool for patients at risk of microangiopathic complications.