🖐️ Nailfold Capillaroscopy Scleroderma Screening Simulator

Positioning the Dermatoscope at the Nailfold

Probe placed at the cuticle to view capillary loops directly.

• ×200: Typical magnification (video capillaroscope)
• 8: Fingers examined (excluding thumbs, standard protocol)
• ~10 min: Exam duration (per patient, all digits)
• Yes: Immersion oil use (improves optical clarity)

Why the nailfold is examined

Capillaries here run parallel to the skin, easy to view directly.

Who gets screened

Raynaud's patients are screened to catch scleroderma early.

The Healthy Nailfold Capillary Architecture

Loops are regular, evenly spaced, uniform hairpin shape.

• 9–14 /mm: Normal density (loops along nailfold row)
• 0: Giant loops expected (in a healthy pattern)
• <20 µm: Loop diameter (apical limb width)
• Regular: Row arrangement (parallel, evenly spaced)

Normal hairpin morphology

Each loop shows a thin afferent and efferent limb, smooth turn.

Baseline for comparison

This pattern is the reference used to flag abnormal findings.

Early Scleroderma — First Capillary Changes

A handful of loops dilate; density starts to drop slightly.

• 1–3: Giant capillaries (per mm, scattered)
• Mild ↓: Density change (still near-normal count)
• Rare: Hemorrhages (occasional microbleed)
• Mostly preserved: Architecture (slight irregularity)

First sign: giant loops

Isolated enlarged capillaries are the earliest detectable clue.

Clinical relevance

Early pattern can precede overt disease by months to years.

Active Scleroderma — Frequent Giants and Hemorrhage

Many giant loops, visible hemorrhages, moderate capillary loss.

• 4–8: Giant capillaries (per mm, frequent)
• Common: Hemorrhages (multiple per field)
• Moderate ↓: Density change (noticeable loop dropout)
• Disrupted: Architecture (irregular spacing)

Active-stage hallmark

Frequent giants plus hemorrhages define the active pattern.

Monitoring implications

This pattern often prompts closer systemic monitoring.

Late Scleroderma — Avascular Fields and Neoangiogenesis

Severe capillary loss, disorganized bushy regrowth vessels.

• Extensive: Avascular fields (large loop-free zones)
• Severe ↓: Density change (<2 loops/mm typical)
• Present: Bushy / ramified loops (neoangiogenesis)
• Fully disorganized: Architecture (loss of parallel rows)

Loss and regrowth together

Avascular zones sit beside chaotic new bushy vessels.

End-stage significance

Late pattern correlates with more advanced organ involvement.

Placeholder: late pattern is the strongest capillaroscopic risk marker.