How to select the most appropriate capillaroscopic device : pros and cons

Nailfold capillaroscopy is a noninvasive technique that allows direct observation of capillaries using a magnification lens for the two-dimensional projection of the three-dimensional capillary network. After application of a drop of immersion oil, capillaries can be observed with a magnification lens because they run parallel to the epidermis at the nailfold area. A number of different instruments are available to perform the exam. They have different characteristics in terms of their cost, quality of images, magnifications, training period, software for image analysis and storage. Some of these instruments can be used both in clinical and research settings such as the stereomicroscope and the videocapillaroscope. The stereomicroscope allows the widefield visualization of the nailfold with low magnifications, the training is relatively short, but the examination is difficult to perform in patients with digital contractures. There appears to be consensus regarding the use of videocapillaroscopy that allows a detailed visualisation of capillary morphology using higher magnifications (100–300x). Contact probe with polarized light microscopy permits easier observation of the skin surface, and the training period is briefer. Specific softwares are available for images analysis, storage, and complete medical reports (text + images) can be produced. By contrast, in a clinical setting, nailfold capillaries can generally be visualised using more simple but also efficient tools such as a dermatoscope, USB microscope, ophtamloscope or smartphone device. The quality of images can be quite good, although the lower magnification means that some details are unlikely to be seen, and they often lack the possibility of image storage and measurement.