Nailfold Capillaroscopy

Abstract

Capillaroscopy is a technique based on the analysis of in vivo direct images of the cutaneous microcirculation. Due to the fact that it is a non-invasive procedure can be applied to both children and adults. In the present communication it is briefly described the periungual capillaroscopy, its scoring, indications, and diagnostic utility as well as a prognostic factor in rheumatic diseases. The optical devices for capillaroscopy are either light or digital microscope with a magnifying power of 40 to 200x that permit to observe the capillaries structure and function. In healthy individuals the normal pattern is described as follows: a) capillary crown with delicate red elements resembling an inverted U with the arms parallel to the finger longitudinal axis; b) capillary density per mm2 is 7 to 17; c) delicate superficial vascular plexus and d) microvascular preserved function, visualized as defined structures without interference, absence of hemorrhage or exudates and preserved perfusion. Altered patterns show structural modified capillaries and disordered capillary bed. The most characteristic pathological patterns are: a) sclerodermiform (megacapillaries, decrease or loss of capillaries, neoformation of blood vessels, distorted bed structure, serpentine-like and glomerular capillaries); and b) systemic lupus erythematosus type with increased tortuousness affecting the three parts of the capillary with meanders or corkscrew or circumvolution and increased length. Capillaroscopy in rheumatic diseases shows microvascular pathological patterns described for primary and secondary Raynaud's disease, systemic scleroderma, connective tissue mixed disease, dermatomyositis, systemic lupus erythematosus, rheumatoid arthritis, Sjögren's syndrome, antiphospholipid syndrome and pso riasis.