Capillaroscopy Opens A Window to Look Inside

Abstract

Editorial Capillaroscopy is an old but actual inexpensive imaging technique, used to examine, non-invasively and safely, the morphology of nailfold dermal papillary capillaries. In the nailfold distal capillary row the dermal papillae run parallel to the surface of the nail, subsequently the capillaries of the distal row are visible in their whole length and appear as red, hairpin-shaped loops [1]. Johan Christophorus Kolhaus, first in 1663, had the idea to observe small vessels around the nails using a rudimentary microscope and about a hundred years later Giovanni Rasori (1766-1873), described the " inextricable knot of capillary loops " observed with a magnifying glass in inflamed conjunctives. After almost another hundred years, Maurice Raynaud (1834-1881), with his studies on local ischemic damage, validated and promoted capillaroscopy as a fundamental imaging technique for the study of microcirculation. In 2013 the power of the non-invasive nailfold videocapillaroscopy (NVC) technique, has been recognized for the early diagnosis of the scleroderma spectrum diseases, its predictivity and prognostic value, as well as its role as a tool for the therapeutic follow up. After more than 30 years of intensive investigation, capillaroscopy is now officially considered by the EULAR and ACR guidelines as both an essential and mandatory diagnostic tool for the classification criteria of systemic sclerosis. ACR/EULAR stated in the 2013 guidelines for classification criteria of systemic sclerosis (SSc):"Capillaroscopy is now widely used, and considering the value of magnified nailfold visualization in the diagnosis and management of SSc, these new criteria may encourage acquisition of this skill by physicians caring for SSc patients" [2]. Several different devices can be used for the capillaroscopic analysis: the widefield microscope, the dermatoscope, the video capillaroscope, the ophthalmoscope.The digital video capillaroscope, which consists of a microscope assembled with a digital videocamera, represents the gold standard for assessing or measuring capillaroscopic parameters. It not only allows low magnification, but also has the advantage of having sequential high magnifications which enable detailed observations of separate capillaries. Furthermore it allows direct contact with the nailfold, facilitating examination of patients with severe finger flexion contractures. In order to evaluate capillaries, a drop of cedar oil has to be placed on the finger nailfold. A precise morphologic evaluation may be obtained by examining the fourth and the fifth finger of both hands due to the high transparency of the skin in these areas.