capillaroscopic

Capillaroscopy, or capillaroscopic examination, is a non-invasive imaging technique used to visualize the microcirculation, particularly the capillaries in the nailfold. It provides information about capillary density, morphology, and architecture, aiding assessment of microvascular health in various diseases.

The most common method is videocapillaroscopy, sometimes called nailfold capillaroscopy. It uses a high-magnification video microscope or digital imaging system to capture live images of capillaries in the nailfold. The examination is typically performed with the hands warm, the digits immersed in oil to improve optical contact, and multiple fields examined on several digits to evaluate capillary density, loop morphology, and the presence of abnormalities.

Key features assessed include capillary density (capillaries per millimeter), loop shape and size, tortuosity, dilated or giant capillaries, microhemorrhages, and avascular areas. Normal capillaries are evenly spaced with uniform, hairpin-shaped loops. Abnormal findings may include elongated, tortuous loops; giant capillaries; hemorrhages; and areas with reduced or absent capillaries.

Interpretation of patterns is clinically important in rheumatology and related fields. In systemic sclerosis, for example, distinct patterns are described as early, active, and late, reflecting progressive microvascular injury, with increasing numbers of giant capillaries and hemorrhages and eventual capillary loss. Capillaroscopy is also used to differentiate primary from secondary Raynaud’s phenomenon and to support the diagnosis and monitoring of other connective tissue diseases such as dermatomyositis and Sjögren’s syndrome.

Limitations include operator dependence, inter- and intra-observer variability, and the influence of environmental factors or technique. Standardized protocols and normative data, coordinated by professional societies, help improve reliability and comparability of findings.