A window into the vascular endothelium in COVID-19: Nails
Keywords:
Proximal nailfold dermoscopy, COVID-19, CapillaroscopyAbstract
Introduction: Endothelial damage is associated with acute and long-term Coronavirus disease 2019 (COVID-19) complications. Proximal nailfold capillaries are windows for monitoring important microvascular changes associated with endothelial dysfunction.
Objective: We aimed to use dermoscopy to examine the proximal nailfold capillaries of COVID-19 patients and identify microvascular changes.
Methods: A prospective study was designed to evaluate the dermoscopic features of proximal nail fold capillaries in mild to moderate COVID-19 patients and healthy controls between June 2022 and December 2023. The patients underwent their initial dermoscopic examination 2 weeks after the onset of symptoms, followed by a follow-up evaluation 10-14 months later.
Results: The study included 46 patients with mild-to-moderate COVID-19 and 62 healthy controls. The presence of avascular areas (P<0.001), meandering capillaries (P=0.016), microhemorrhages (P=0.007), and enlarged capillaries (p=0.009) in the proximal nail fold is significantly higher in COVID-19 patients than in healthy controls The capillary architecture was disorganized (P=0.002) and density reduced (P<0.001) in COVID-19 patients compared to healthy controls. In the follow-up examination, microvascular changes were observed to regress.
Conclusions: Proximal nailfold dermoscopy is an effective, low-cost, and easily accessible method that enables observing microvascular changes in COVID-19 patients.
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