Nailfold capillaroscopy as a useful tool for early detection of cardiovascular risk in psoriatic patients

Background Psoriasis is increasingly recognized as a multisystem inflammatory disorder with significant metabolic and cardiovascular comorbidities. Metabolic syndrome (MetS) is a major contributor to cardiovascular risk in psoriatic patients, yet its impact on microvascular health remains underexplored. Nailfold video capillaroscopy (NVC) is a noninvasive imaging technique that allows for early detection of microvascular alterations, potentially serving as a marker for cardiovascular risk in psoriatic patients. Objective To compare NVC findings in psoriatic patients with and without MetS and correlate them with carotid intima-media thickness. Patients and methods A cross-sectional study was conducted on 65 patients with moderate to severe psoriasis, classified into two groups: psoriasis with MetS (MetG) and psoriasis without MetS (PsoG). NVC was performed to evaluate capillary density, morphology, length, width, and microvascular abnormalities. Carotid intima-media thickness was also assessed to determine its correlation with microvascular changes and systemic cardiovascular risk. Results Patients with psoriasis and MetS exhibited significantly greater microvascular alterations compared to the psoriasis-only group, including elongated and dilated capillaries, decreased capillary density, and increased edema and hemorrhage. These changes were significantly correlated with higher carotid intima-media thickness values, indicating an association between microvascular dysfunction and subclinical atherosclerosis in psoriatic patients with MetS. Conclusion NVC provides insights into microvascular health in psoriasis, particularly in patients with MetS. The findings suggest an association between NVC-detected alterations and established cardiovascular risk markers. This highlights the potential of NVC as a tool for studying microvascular pathology in psoriasis.