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PubMed This is a summary of 17 peer-reviewed journal articles Updated
Rheumatology · Systemic Sclerosis

What Is a Nailfold Capillaroscopy for Scleroderma?

At a Glance

A nailfold capillaroscopy is a painless microscope exam of the cuticles used to check for tiny blood vessel damage. It helps doctors distinguish between benign Raynaud's disease and autoimmune conditions like scleroderma by identifying specific patterns of capillary damage.

In this answer

3 sections

01

Distinguishing Between Types of Raynaud’s

02

The “Scleroderma Patterns” Explained

03

Why the Results Matter for Your Care

When your doctor placed oil on your cuticles and examined them under a microscope, they were performing a completely painless test called a nailfold capillaroscopy (a non-invasive imaging technique used to look closely at the tiny blood vessels at the base of your fingernails) [1]. The oil, known as immersion oil, is used to make the tough outer layer of your skin transparent by preventing light from scattering, which gives the doctor a clear, unobstructed view of the structures underneath [2]. By looking at the size, shape, and density of these blood vessels, your doctor was searching for specific signs of microvascular damage to determine whether your cold hands are caused by a benign condition (primary Raynaud’s disease) or if they are related to an underlying autoimmune condition like scleroderma [3][4].

Distinguishing Between Types of Raynaud’s

Raynaud’s phenomenon—the condition where fingers turn white, blue, and red in response to cold or stress—happens in both primary Raynaud’s disease and systemic sclerosis (scleroderma). However, the underlying health of the blood vessels is very different:

  • Primary Raynaud’s: The tiny blood vessels, or capillaries, look completely normal, uniform, and healthy under the microscope [3][5].
  • Secondary Raynaud’s (such as in Scleroderma): The capillaries show distinct physical abnormalities, often referred to as the “scleroderma pattern” [4][1].

Spotting a scleroderma pattern helps doctors accurately diagnose the disease, sometimes even before other noticeable skin or internal symptoms emerge [6][7].

The “Scleroderma Patterns” Explained

If a patient has systemic sclerosis, the microscopic changes in their capillaries typically fall into one of three classifications: early, active, or late [8][9]. These patterns reflect how the disease is affecting the microscopic blood vessels.

Pattern Stage Description of Blood Vessels Key Features Seen Under the Microscope
Early Minor structural changes with mostly normal density. A few giant capillaries (abnormally enlarged, swollen blood vessels) and minor microhemorrhages (tiny spots of bleeding), while the overall number and arrangement of vessels remain relatively normal [8][10].
Active Increased damage and noticeable loss of vessels. Frequent giant capillaries, frequent microhemorrhages, and a moderate loss of healthy capillaries leading to a disorganized appearance [8][10].
Late Severe vessel loss and abnormal new growth. Severe capillary drop-out (large areas where blood vessels are completely missing or avascular), few or no giant capillaries, and the appearance of bushy capillaries (branched, tree-like vessels that represent the body’s flawed attempt to grow new blood vessels, a process called neoangiogenesis) [8][11].

While these classifications are called “stages,” it is important to know that they do not strictly dictate how long you have had the disease. A patient might show an “early” pattern even after having symptoms for years, or vice versa [12][13].

Why the Results Matter for Your Care

Nailfold capillaroscopy is not just used to make an initial diagnosis; it is also a highly reliable tool for assessing your overall disease activity so that your medical team can intervene early [8][1]. The extent of the damage seen under the microscope helps doctors understand the overall health of your blood vessels throughout your entire body.

  • Predicting Digital Ulcers: Severe microvascular damage, particularly a “late” pattern with significant capillary loss, tells your doctor you may be at high risk for developing digital ulcers (painful sores on the tips of the fingers) [7][14].
  • Monitoring Internal Health: The progression of capillary damage is often linked to the severity of internal organ disease, specifically predicting the risk and progression of interstitial lung disease (scarring of the lungs) and pulmonary arterial hypertension (high blood pressure in the lungs) [15][16][17].

While reading about these risks can be alarming, this information is highly empowering. Identifying these risks early allows your doctor to proactively prescribe treatments—such as medications that help keep blood vessels open—to protect your tissues and organs [8]. Because nailfold capillaroscopy is non-invasive and painless, your doctor can easily repeat this test at future visits to monitor how your blood vessels are responding to your management plan over time [8][9].

Common questions in this guide

What is a nailfold capillaroscopy?
It is a painless, non-invasive test where a doctor places oil on your cuticles and uses a microscope to look at the tiny blood vessels at the base of your fingernails. This helps them check for microvascular damage.
Why does the doctor put oil on my cuticles during a capillaroscopy?
Immersion oil makes the tough outer layer of your skin transparent by stopping light from scattering. This simple step gives your doctor a clear, unobstructed view of the microscopic blood vessels underneath your skin.
How does capillaroscopy tell the difference between primary and secondary Raynaud's?
In primary Raynaud's, the tiny blood vessels look completely normal and healthy under the microscope. In secondary Raynaud's linked to scleroderma, the vessels show distinct physical abnormalities like severe swelling, disorganized patterns, or tiny spots of bleeding.
What does a late scleroderma pattern mean on my capillaroscopy results?
A late pattern shows severe loss of blood vessels, called capillary drop-out, alongside abnormal new vessel growth. This stage alerts your doctor that you may be at a higher risk for painful digital ulcers or internal organ issues.
Do my capillaroscopy results tell me how long I have had scleroderma?
No, the early, active, and late patterns do not dictate how long you have had the disease. You might show an early pattern even after having symptoms for years, which is why regular monitoring is so important.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.What specific pattern (early, active, or late) did my capillaries show today during the capillaroscopy?
  2. 2.Did you observe any severe capillary drop-out or damage that suggests I am at a higher risk for digital ulcers or internal organ involvement?
  3. 3.How frequently will we repeat the nailfold capillaroscopy to monitor my microvasculature over time?
  4. 4.Based on these results, are there proactive treatments we should discuss to help protect my blood vessels and preserve my circulation?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

Related questions

Does Anti-RNA Polymerase III Increase Cancer Risk?How Does Scleroderma Affect Your Teeth and Mouth?Does Morphea Turn Into Systemic Sclerosis?Eosinophilic Fasciitis vs Scleroderma: Key DifferencesHow Do I Find a Scleroderma Specialist?How Do You Stop a Raynaud's Attack in Scleroderma?How to Manage Scleroderma GERD: Sleep Positions & TipsScleroderma mRSS: Modified Rodnan Skin Score ExplainedWhy Does Scleroderma Cause Bloating & Bowel Issues?What is the Life Expectancy with Scleroderma?How to Do Mouth Stretching Exercises for SclerodermaWhy Do Scleroderma Fingers Change From Puffy to Tight?Can You Have Scleroderma Without Skin Changes?Why Are Corticosteroids Dangerous in Scleroderma?

References

References (17)
  1. 1

    Clinical utility of nailfold capillaroscopy.

    Roberts-Thomson PJ, Patterson KA, Walker JG

    Internal medicine journal 2023; (53(5)):671-679 doi:10.1111/imj.15966.

    PMID: 36353844
  2. 2

    Nailfold Capillaroscopy in Rheumatic Diseases: Which Parameters Should Be Evaluated?

    Etehad Tavakol M, Fatemi A, Karbalaie A, et al.

    BioMed research international 2015; (2015()):974530 doi:10.1155/2015/974530.

    PMID: 26421308
  3. 3

    Nailfold dermoscopy predicts the absence of a capillaroscopy sclerodermic pattern: The multicentre, prospective VASCUL-R trial.

    Monfort JB, Klejtman T, Lazareth I, et al.

    Journal of the European Academy of Dermatology and Venereology : JEADV 2024; (38(10)):1982-1987 doi:10.1111/jdv.19803.

    PMID: 38251814
  4. 4

    Nailfold capillaroscopy for the early diagnosis of the scleroderma spectrum of diseases in patients without Raynaud's phenomenon.

    Hong C, Xiang L, Saffari SE, Low AH

    Journal of scleroderma and related disorders 2022; (7(2)):144-150 doi:10.1177/23971983221088460.

    PMID: 35585956
  5. 5

    Imaging of connective tissue diseases: Beyond visceral organ imaging?

    Cutolo M, Damjanov N, Ruaro B, et al.

    Best practice & research. Clinical rheumatology 2016; (30(4)):670-687 doi:10.1016/j.berh.2016.10.002.

    PMID: 27931961
  6. 6

    Raynaud's phenomenon and nailfold capillaroscopic findings in anorexia nervosa.

    De Martinis M, Sirufo MM, Ginaldi L

    Current medical research and opinion 2018; (34(3)):547-550 doi:10.1080/03007995.2017.1417828.

    PMID: 29292666
  7. 7

    Endothelial Dysfunction and Nailfold Videocapillaroscopy Pattern as Predictors of Digital Ulcers in Systemic Sclerosis: a Cohort Study and Review of the Literature.

    Silva I, Teixeira A, Oliveira J, et al.

    Clinical reviews in allergy & immunology 2015; (49(2)):240-52 doi:10.1007/s12016-015-8500-0.

    PMID: 26142066
  8. 8

    Nailfold capillaroscopy in systemic sclerosis - state of the art: The evolving knowledge about capillaroscopic abnormalities in systemic sclerosis.

    Lambova SN, Müller-Ladner U

    Journal of scleroderma and related disorders 2019; (4(3)):200-211 doi:10.1177/2397198319833486.

    PMID: 35382505
  9. 9

    Capillaroscopy in Routine Diagnostics: Potentials and Limitations.

    Ingegnoli F, Smith V, Sulli A, Cutolo M

    Current rheumatology reviews 2018; (14(1)):5-11 doi:10.2174/1573397113666170615084229.

    PMID: 28641553
  10. 10

    Advances in nailfold capillaroscopic analysis in systemic sclerosis.

    Ruaro B, Sulli A, Smith V, et al.

    Journal of scleroderma and related disorders 2018; (3(2)):122-131 doi:10.1177/2397198318757699.

    PMID: 35382238
  11. 11

    The usefulness of nailfold capillaroscopy in "scleroderma-spectrum" disorders.

    Wielosz E

    Reumatologia 2021; (59(5)):273-275 doi:10.5114/reum.2021.110323.

    PMID: 34819700
  12. 12

    Prevalence, distribution and associations of the scleroderma capillaroscopic patterns: new insights from the Italian SPRING-SIR registry.

    De Angelis R, Ferri C, Cipolletta E, et al.

    Rheumatology (Oxford, England) 2026; (65(1)) doi:10.1093/rheumatology/keaf672.

    PMID: 41392303
  13. 13

    Sequential nailfold videocapillaroscopy examinations have responsiveness to detect organ progression in systemic sclerosis.

    Avouac J, Lepri G, Smith V, et al.

    Seminars in arthritis and rheumatism 2017; (47(1)):86-94 doi:10.1016/j.semarthrit.2017.02.006.

    PMID: 28291582
  14. 14

    Combination of Capillaroscopic and Ultrasonographic Evaluations in Systemic Sclerosis: Results of a Cross-Sectional Study.

    Lescoat A, Coiffier G, de Carlan M, et al.

    Arthritis care & research 2018; (70(6)):938-943 doi:10.1002/acr.23413.

    PMID: 28898558
  15. 15

    Prognostic value of baseline nailfold videocapillaroscopy in predicting pulmonary decline and disease progression in SSc.

    Sieiro Santos C, Martínez JO, Antolín SC, et al.

    Rheumatology (Oxford, England) 2025; (64(12)):6090-6098 doi:10.1093/rheumatology/keaf361.

    PMID: 40600932
  16. 16

    Nailfold Videocapillaroscopy in Systemic Sclerosis-related Pulmonary Arterial Hypertension: A Systematic Literature Review.

    Smith V, Vanhaecke A, Vandecasteele E, et al.

    The Journal of rheumatology 2020; (47(6)):888-895 doi:10.3899/jrheum.190296.

    PMID: 31416927
  17. 17

    Can microvascular damage predict disease severity in patients with systemic sclerosis?

    Martins A, Pimenta S, Oliveira D, et al.

    Reumatologia clinica 2024; (20(7)):366-371 doi:10.1016/j.reumae.2024.07.006.

    PMID: 39160008

This page explains nailfold capillaroscopy procedures and results for educational purposes. Always consult your rheumatologist or healthcare provider to interpret your specific exam findings and diagnosis.

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