Turkiye Klinikleri Journal of Dermatology

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Tırnak Kıvrımı Dermoskopisinin Gücünü Ortaya Çıkarmak: Raynaud Fenomenini Evreleme: Olgu Kontrol Araştırması
Unveiling the Power of Nailfold Dermoscopy: Staging Raynaud's Phenomenon: Case Control Research
Güzin SAMAV SARIa , Mustafa Turhan ŞAHİNb
aSerbest Hekim, Eskişehir, Türkiye
bCelal Bayar Üniversitesi Tıp Fakültesi, Dermatoloji AD, Manisa, Türkiye
Turkiye Klinikleri J Dermatol. 2024;34(2):68-74
doi: 10.5336/dermato.2023-100730
Article Language: TR
Full Text
ÖZET
 Amaç: Raynaud fenomeni (RF), vazokonstriktif ataklarla karakterize bir durumdur ve tırnak kıvrımı dermoskopisi veya videokapilleroskopi kullanılarak tanısı konulabilir. Bu çalışmada, RF'li hastalar ile kontrol grubu arasındaki tırnak kıvrımı dermoskopisindeki farklılıkların araştırılması amaçlandı. Gereç ve Yöntemler: Çalışmaya RF'li 42 hasta ve kontrol grubunda 33 kişi dâhil edildi. Her parmak tırnak kıvrımının, dermoskopik ve klinik fotoğrafları çekildi ve sonuç olarak modifiye Maricq kriterlerine göre 4 gruba ayrılan 750 görüntü elde edildi: normal, şüpheli kılcal damar genişlemesi, anormal dev kılcal damarlar-hemorajiler ve sınıflandırılmamış olarak kategorize edildi. Evrelemenin tutarlılığını değerlendirmek için, derecelendirme yapmaları istenen 69 dermatoloğa 40 rastgele fotoğraf gösterildi. Bulgular: Hasta grubundaki 27 hastada altta yatan bir hastalık mevcuttu ve bu hastalardaki RF, sekonder RF olarak değerlendirildi. Tırnak kıvrımı dermoskopisi aşamaları şu şekilde kategorize edildi: %31'i evre 2, %28,6'sı evre 3, %28,6'sı evre 1 ve %11,9'u evre 4. Gözlemciler arası güvenilirlik analizi %69,56, gözlemciler için güvenilirlik ise %75,36 idi (Cohen kappa>41). Çalışma, tırnak kıvrımı dermoskopisinin hem gözlemciler arası hem de gözlemciler içinde güvenilirliğe sahip olduğunu ve minimum eğitimle bile kapiller anormalliklerinin tespitinde kullanılabileceğini buldu. Bu nedenle RF'li hastalarda, eşlik eden hastalıkların erken tanısında yararlı bir teknik olabilir. Sonuç: Bu çalışmanın dikkate değer bir yönü, genel kapilleroskopik görünümü derecelendirmek için tanımlayıcı, basit bir sıralı şiddet skorunun kullanılmasıydı. Genel olarak, RF'nin tanısında tırnak kıvrımı dermoskopisinin yaygın kullanımı, eşlik eden hastalıkların erken tespiti için yararlı bir araç olabilir.

Anahtar Kelimeler: Dermoskopi; Raynaud fenomeni; kapilleroskopi
ABSTRACT
 Objective: Raynaud's phenomenon (RP) is a condition characterized by vasoconstrictive attacks, and it can be diagnosed using nail-fold dermoscopy or videocapilloscopy. This study aimed to investigate the differences in nail-fold dermoscopy between patients with RP and a control group. Material and Methods: The study included 42 patients with RP and 33 individuals in the control group. Dermoscopic and clinical photographs of each finger nailfold were taken, resulting in 750 images that were categorized into 4 groups based on modified Maricq criteria: normal, suspect-capillary dilatation, abnormal-giant capillaries-hemorrhages, and unclassified. To assess the consistency of the staging, 40 random photographs were shown to 69 dermatologists who were asked to provide a rating. Results: The patient group had an underlying disease in 27 patients and the RF in these patients were evaluated as secondary RP. The nail-fold dermoscopy stages were categorized as follows: 31% stage 2, 28.6% stage 3, 28.6% stage 1, and 11.9% stage 4. The inter-observer reliability analysis was 69.56%, and the intra-observer reliability was 75.36%, with Cohen kappa >41. The study found that nail-fold dermoscopy has both inter-observer and intraobserver reliability, and it can be used for the detection of capillary abnormalities, even with minimal training. Therefore, it can be a useful technique in the early diagnosis of concomitant diseases in patients with RP. Conclusion: One notable aspect of this study was the use of a descriptive, simple ordinal score of severity to grade the overall capillaroscopic appearance. Overall, the widespread use of nail-fold dermoscopy in the diagnosis of Raynaud's phenomenon can be a useful tool for early detection of concomitant diseases.

Keywords: Dermoscopy; Raynaud phenomenon; capillaroscopy
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