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2015, Número S1

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Med Cutan Iber Lat Am 2015; 43 (S1)


Capilaroscopia periungueal

Leroux MB

Idioma: Español
Referencias bibliográficas: 45
Paginas: 17-27
Archivo PDF: 803.53 Kb.


RESUMEN

La capilaroscopia es una técnica de estudio mediante imágenes directas in vivo de la microcirculación cutánea que, por su carácter incruento, puede realizarse en niños y adultos. En este escrito se consignan en forma breve las bases sobre la capilaroscopia periungueal: su registro, indicaciones, utilidad como metodología diagnóstica y factor pronóstico en enfermedades reumáticas. Los instrumentos óptimos para su realización son microscopios ópticos o digitales con aumento de 40X a 200X, los cuales nos permiten observar la estructura y función de los capilares. En sujetos sanos, se describe una imagen considerada como patrón normal cuando: a) Se observa una corona capilar con elementos rojos, delicados, con forma de U invertida y paralelos al eje longitudinal del dedo; b) La densidad capilar/mm2 es de 7 a 17; c) El plexo vascular superficial delicado; y d) Se halla una función microvascular preservada (visualización definida de las estructuras sin interferencias, ausencia de hemorragias o exudados y perfusión conservada). Los patrones patológicos muestran alteraciones estructurales de los capilares y desorden del lecho capilar, siendo los más característicos: a) tipo esclerodermiforme (megacapilares, disminución o pérdida de capilares, vasos de neoformación, alteración de la estructura del lecho, serpenteo y ovillo capilar) y b) tipo lupus eritematoso sistémico (aumento de tortuosidad que afecta a las tres partes del capilar con meandros, en sacacorchos o circunvoluciones y aumento de longitud). La capilaroscopia en enfermedades reumáticas consigna los cambios microvasculares en: Raynaud primario y secundario, esclerodermia sistémica, enfermedad mixta de tejido conectivo, dermatomiositis, lupus eritematoso sistémico, artritis reumatoide, síndrome de Sjögren, síndrome anticuerpo antifosfolípido y psoriasis.


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