Fundamentals of capillaroscopy
Core conceptual and clinical foundations for rigorous interpretation of nailfold capillaroscopy.
Overview
Modules and units
Choose a module and jump straight into the unit you need. Each block is ordered so you can keep context without reading a long roadmap first.
20Available units7Modules
Module 1Foundations3 unitsModule 2Technique and workflow3 unitsModule 3Interpretation2 unitsModule 4Initial clinical application3 unitsModule 5Systemic sclerosis2 unitsModule 6Other autoimmune diseases5 unitsModule 7Transversal extensions2 units
Module 1
Foundations
What capillaroscopy is, why the periungual region matters, and which anatomy and classical reading frameworks you need before interpreting anything.
1.1Introduction to nailfold capillaroscopyDefinition, technique variants, current clinical role, limits, and historical development of nailfold capillaroscopy.Start unit1.2Nailfold microcirculation: anatomy, physiology, and baseline findingsCapillary loop architecture, exchange physiology, and practical criteria to distinguish normal variation from microangiopathy.Start unit1.3Classical semi-quantitative and quantitative capillaroscopy interpretationHow to move from global reading to classical scoring, integrate the Maricq and Cutolo patterns, and understand which metrics remain useful today.Start unit
Module 2
Technique and workflow
Equipment, acquisition, quality control, quantification, and AI. This block gathers what you need for usable and comparable studies.
2.1Equipment and devices for capillaroscopyHow to choose between videocapillaroscopy, dermoscopy, and USB microscopes according to field of view, traceability, and clinical context.Start unit2.2Image acquisition, quality control, and complementary techniquesPatient preparation, capture protocol, quality control, and the current role of quantification and complementary techniques.Start unit2.3AI, quantification, and reproducibility in capillaroscopyWhat current algorithms measure, how they compare with expert readers, the role of external validation, and where the real limits of AI in capillaroscopy still lie.Start unit
Module 3
Interpretation
Normality, variability, descriptive language, and reporting. This is where you learn not to overcall and how to write useful conclusions.
3.1Normal capillaroscopy: variability, artifacts, and the limits of normalityHow to recognize a normal study, which variations remain nonspecific, and which technical or biological factors complicate interpretation.Start unit3.2Capillaroscopy semiology and reportingDescriptive language, elementary findings, quantification rules, and the minimum structure needed for a useful and reproducible report.Start unit
Module 4
Initial clinical application
When to request the test, how to use it in Raynaud's phenomenon, and how to distinguish it from other acrosyndromes before disease-specific chapters.
4.1Indications and clinical utility of capillaroscopyWhen to request the test, which clinical questions it can answer, and where the evidence remains limited.Start unit4.2Raynaud's phenomenon: diagnosis, risk stratification, and initial managementHow to confirm the syndrome, distinguish primary from secondary forms, integrate capillaroscopy and serology, and decide on initial management.Start unit4.3Other vascular acrosyndromes: acrocyanosis, erythromelalgia, and differentialsPractical differential diagnosis between Raynaud and other acrosyndromes: acrocyanosis, erythromelalgia, perniosis, livedo, and causes of digital ischemia.Start unit
Module 5
Systemic sclerosis
A dedicated block for the scleroderma pattern, classification, vascular prognosis, and longitudinal follow-up.
5.1Systemic sclerosis: scleroderma pattern, criteria, and classificationHow to recognize the scleroderma pattern, integrate it with VEDOSS and ACR/EULAR criteria, and distinguish it from non-scleroderma patterns.Start unit5.2Systemic sclerosis: prognosis, digital ulcers, and longitudinal follow-upAssociations between capillaroscopy and vascular damage, digital ulcers, cardiopulmonary involvement, and longitudinal risk in systemic sclerosis.Start unit
Module 6
Other autoimmune diseases
Overlap disease, inflammatory myopathies, lupus, APS, and vasculitis, where capillaroscopy mainly contributes phenotype context and stratification.
6.1MCTD and overlap connective tissue disease: the role of capillaroscopyWhich capillaroscopic findings are frequent in MCTD, how they relate to pulmonary hypertension and interstitial involvement, and why a scleroderma-like pattern does not automatically mean systemic sclerosis.Start unit6.2Dermatomyositis and inflammatory myopathies: patterns, phenotypes, and follow-upPractical comparison between dermatomyositis, antisynthetase syndrome, and other inflammatory myopathy phenotypes, focusing on the scleroderma-like pattern, activity, and reversibility.Start unit6.3Inflammatory myopathies: autoantibodies, anti-MDA5, and prognostic valueHow to integrate myositis-specific autoantibodies, capillaroscopic pattern, and the risk of ILD, cancer, or persistent activity without overstating the available evidence.Start unit6.4Systemic lupus erythematosus: nonspecific microangiopathy, Raynaud, and anti-RNPWhat capillaroscopy can add in SLE, how to interpret Raynaud and anti-U1-RNP, and why a scleroderma-like pattern does not automatically mean overlap disease.Start unit6.5APS and vasculitis: what capillaroscopy can add and what it cannotHemorrhages, anticoagulation bias, and emerging usefulness in ANCA vasculitis, Behçet syndrome, and cutaneous vasculitis without overstating the evidence.Start unit
Module 7
Transversal extensions
Units that expand the map beyond the central pathway, such as pediatrics or diabetes, without changing the core learning sequence.
7.1Capillaroscopy in pediatrics: normality, Raynaud, and juvenile rheumatic diseasesHow to interpret capillaroscopy in children and adolescents, what differs from adults, and where evidence is strongest in Raynaud, juvenile systemic sclerosis, and juvenile dermatomyositis.Start unit7.2Capillaroscopy and diabetes: microangiopathy, type 2 diabetes, and microvascular riskWhich findings recur in diabetes, how they relate to retinopathy and nephropathy, and why current usefulness is stronger in research and exploratory stratification than in routine screening.Start unit
Show framework references
- Smith V, et al. Nailfold capillaroscopy. Best Pract Res Clin Rheumatol. 2023;37(1):101849.
- Smith V, et al. Standardisation of nailfold capillaroscopy for the assessment of patients with Raynaud's phenomenon and systemic sclerosis. Autoimmun Rev. 2020;19(3):102458.
- Bellando-Randone S, et al. Progression of patients with Raynaud's phenomenon to systemic sclerosis: VEDOSS registry. Lancet Rheumatol. 2021;3(12):e834-e843.