In short
Nail fold capillaroscopy is a painless five-minute examination of the tiny blood vessels at the base of the fingernails, using a specialised microscope. It answers one question that blood tests often cannot: whether fingers that change colour in the cold are harmless, or the earliest sign of a connective tissue disease such as systemic sclerosis.
Why it is done
Around one in ten people has Raynaud's phenomenon — fingers turning white, then blue, then red on cold exposure. In most it is primary: uncomfortable but harmless, and it stays that way for life. In a minority it is secondary, the first visible sign of scleroderma, mixed connective tissue disease, lupus or dermatomyositis, sometimes appearing years before anything else.
Telling the two apart from the history alone is unreliable. Capillaroscopy makes the distinction visible.
What the examination shows
Normal nail fold capillaries are neat, evenly spaced hairpin loops. In secondary Raynaud's they become enlarged, then giant, then start to drop out, leaving avascular areas, with disorganised new vessel growth around them. These "scleroderma patterns" — early, active and late — track the underlying disease and change measurably over time.
What happens on the day
A drop of oil is placed on the skin at the base of the nail and each finger is examined under the microscope. There are no needles, no radiation, nothing to prepare and nothing to recover from. Avoid a manicure in the days before, and keep hands warm on the way to the appointment.
What the result changes
A clearly normal pattern in someone with cold-sensitive fingers and negative antibodies is strong reassurance. An abnormal pattern changes the plan completely: it prompts antibody testing, lung function assessment and long-term monitoring, and it is the reason some patients are diagnosed early enough to protect organ function.
Conditions this is used for
These are the conditions in which Nail Fold Capillaroscopy forms part of the assessment or the treatment plan. It is not a complete list, and whether it applies to you is decided at consultation.
- Systemic Sclerosis / Scleroderma
- Connective Tissue Disease-Associated Interstitial Lung Disease (CTD-ILD)
- Raynaud's Phenomenon
- Dermatomyositis
Whether a procedure is appropriate is decided during consultation, based on your symptoms, examination and existing reports.
Book your consultation
Consult Dr. Ashish Baweja at the Institute of Clinical Immunology and Rheumatology, Medanta – The Medicity, Gurugram.