Capillaroscopy makes it possible to visualize the capillaries, namely the smallest vessels of the organism, in order to study the blood micro-circulation. It is useful for guiding the diagnosis of certain pathologies, such as scleroderma in Raynaud’s phenomenon for example. What does this exam consist of? How is it going? When is it prescribed? Dr Raphaël Attal, vascular doctor in the Paris region, answers our questions.
You have been prescribed a capillaroscopy. What is this exam for? What diseases can it detect? How to prepare for this test? To answer all patient questions, we consulted Dr. Raphaël Attal, angiologist.
Definition: what is periungual capillaroscopy?
Capillaroscopy is a quick and totally painless medical imaging examination. It makes it possible to visualize using a microscope – called a capillaroscope – the blood capillaries located at the end of the fingers at the level of the nails. This is called periungual capillaroscopy. A capillary is a very thin blood vessel. Their role is to ensure the nutrition and functioning of the body’s tissues.
If there are blood capillaries anywhere in the body, especially in the muscles, liver, lungs, kidneys and nervous system, but only those located at the end of the fingers can be examined. Capillaroscopy was first described by Lombard in 1912.
Procedure of a capillaroscopy session
Capillaroscopy is a quick, totally painless examination that takes place during a classic consultation. The patient does not need to prepare for it in any way, he will just be asked not to have nail polish on his hands.
- During the consultation, the doctor places a drop of oil or hydro-alcoholic solution on each nail to allow better visualization of the capillaries under the skin.
- The patient puts his hand under the capillaroscope which magnifies between 50 and 200 times the skin of the edge of the nails. The doctor thus observes all the fingers of the two hands with the exception of the thumbs.
- The device, coupled with a camera and a computer, allows him to observe the appearance, number and density of the capillaries, and if necessary to take a few shots.
- It is a direct vision examination, the specialist will therefore deliver a report of his observations immediately to the patient.
- The examination is carried out in a room at ambient temperature, in order to avoid any phenomenon of vasoconstriction linked to the cold. The patient can immediately resume their usual activities following the examination.
- This examination can be combined with digital capillary pressure measurement under a microscope using a tension micro-cuff.
What are the indications for a capillaroscopy?
This examination makes it possible to detect acrosyndromes, which are the most frequent abnormalities of the microcirculation. This examination makes it possible in particular to exclude a possible disease of the vessels which are not visible by echo-Doppler, because they are too small.
“Any cutaneous involvement of the extremities, in particular the phenomena of discoloration of the fingers, may justify performing a capillaroscopy. says Dr. Attal. Raynaud’s phenomenon, recurrent frostbite for example, can be a sign of microcirculatory damage, which can be benign, or reveal an autoimmune disease such as scleroderma or lupus.
“It should be noted that capillaroscopy is not a diagnostic examination, which means that it does not allow a firm diagnosis to be made on its own. On the other hand, it is a valuable aid in diagnosis, and must then be coupled with clinical signs and the results of biological examinations. explains the vascular doctor. The most common diagnosis is scleroderma, a rare autoimmune disease that can be localized or systemic, the latter almost always associated with Raynaud’s phenomenon.
Raynaud’s phenomenon is a blood microcirculation disorder manifested by discoloration of the fingers which may be accompanied by numbness or pain in the extremities, most often in the hands but also in the feet, or even more exceptionally in the toes or of the nose. It is a very frequent phenomenon since it would affect nearly 15% of women in Europe, and 10% of men. “This Raynaud’s phenomenon is most often primitive, ie not linked to an autoimmune disease. The capillaroscopy is then normal, and the fact that it is normal makes it possible to orient the diagnosis in this direction” explains the specialist.
When Raynaud’s phenomenon is linked to scleroderma, the examination reveals the presence of megacapillaries, namely abnormally dilated capillaries, as well as deserted areas, abnormally devoid of capillaries, accompanied by other more specific signs. To learn more about the symptoms, prevention and treatment of Reynaud’s phenomenon, go to our dedicated article “Disease and Raynaud’s phenomenon: symptoms, causes and treatment”.
Capillaroscopy is an examination that helps in diagnosis but is not enough to make a diagnosis. When an autoimmune disease is suspected (lupus, scleroderma, etc.), biological tests are associated with it, such as anti-nuclear antibody assays.
Rates, refunds, appointment times
The periungual capillaroscopy costs 25.24 euros and is covered at 70% by Social Security. It can be done in the hospital or in a private practice with a vascular doctor. There may be excess fees when it is done in office, depending on the agreement of your specialist. “Few structures and practices have a capillaroscope, which explains the generally long delays when making an appointment” says Dr. Attal.
In the hospital, it generally takes 6 months to 1 year to obtain an appointment, and in private practice 3 weeks to 1 month. “But there is never any urgency to carry out this examination“ reassures the specialist.