Capillary Microscopy and Photography

I've made a few corresponding pictures of a patient with a limited form of scleroderma under bosentan (tracleer) therapy. I don't think that we can skip capillary microscopy, but we can train ourselves to see more with the naked eye. Modern digital photography allows pictures from a very short distance without having to use special lenses.

Right index finger:

Right middle finger:

Next time I'll experiment with using oil. It may enhance the capillaries.

Scleroderma, limited form

During late November last year a woman born 1958 developped Raynaud's and ulcers as well as necrosis on different fingertips, most prominent on on the left forefinger. Initial therapy with iloprost didn't get a breakthrough. We started bosentan during December 2011.
The following two pictures were taken on the 1st of Feb. 2012:

The next two pictures were taken on the 5th of March 2012:

Scleroderma / Ulcers on fingers

These pictures belong to a woman suffering from scleroderma. She is 77 years old and signs and symptoms occurred in 2010 for the first time. ESR 39 mm, CRP 7,4 mg/l, complement C3 83.7 mg/dl and C4 5.9 mg/dl, antinuclear antibodies 1:20480 granular, SCL-70 positive. RR 120/70 mm Hg, heart rate 72/min. The photographs show fingers before and after a week of therapy. Current drug therapy: phenprocoumon, a statin, verapamil, Ilomedine at 20 mg/day i.v.

Limited Scleroderma

These pictures show the left forefinger of a 53 year old woman. About 10 days ago the lesion on the digital pulp got a secondary infection and was treated by surgeons with 50 mgs prednisolone and cefuroxim. The yellow staining of the skin is due to the use of a iodine containing disinfectant. Last lab didn’t show inflammation (ESR 23 mm, CRP <3,0 mg/l, Leukocytes 11.9 /nl with a normal differential blood count).


Therapy at the moment: 20 mg prednisolone, 2x62.5 mg Tracleer (bosentan), 100 mg aspirin, 1x10 mg enalapril, 1x5 mg amlodipine, 1x40 mg pantozole, iodine, 20,000 IU cholecalciferole every 2nd week. Prior to bosentan we treated with ilomedine and prostavasine intravenously for 3 weeks.


Other lab counts: Antinuclear antibodies 1:10240, centromer antibodies.