Nailfold Capillaroscopy: A Cost Effective Practical Technique Using Digital Microscope

Nailfold capillaroscopy (NFC) is a simple and non-invasive technique for the analysis

of microvascular abnormalities seen in various systemic connective tissue diseases (SCTD), especially in systemic sclerosis (SSc) group of disorders. The techniques for NFC have evolved over several decades and nailfold video capillaroscope (NVC) is considered the gold standard tool for NFC. Nailfold video capillaroscope is an expensive equipment and usually not available in most developing countries. Other instruments that have been utilised for NFC are a magnifying lens, an ophthalmoscope, a dermatoscope, a stereomicroscope and a wide field microscope. Faced by shortcomings of multiple instruments, we have innovated a cost effective and simple technique for NFC using a handheld and universal serial bus (USB) digital microscope. This article elaborates on the advantages and disadvantages of various instruments and techniques for NFC, with emphasis on our innovative techniques. We recommend USB digital microscope for NFC in clinical practice especially for evaluation of scleroderma-related disorders.

INTRODUCTION

Nailfold capillaroscopy (NFC) is a simple and non-invasive technique for the analysis of microvascular abnormalities seen in various systemic connective tissue diseases (SCTD), especially in systemic sclerosis (SSc) group of disorders.1,2 It is an established fact that the presence of Raynauds phenomenon (RP) should promptly lead to NFC, in order to distinguish between the primary and the secondary RP. Nailfold capillaroscopy has an exceptionally high negative predictive value and good positive predictive value for early distinction between primary and secondary RP. Besides SSc, NFC abnormalities have been documented in several other SCTD and systemic diseases with microangiopathic involvement, such as diabetes mellitus (DM) and coronary artery disease (CAD). The techniques for NFC have evolved over several decades with the advent of technology and experience. Presently, the gold standard tool for NFC is a nailfold video capillaroscope (NVC).3,4 Nailfold video apillaroscope is an expensive equipment and usually not available in most developing countries. Despite the obvious advantages and the undisputed diagnostic value, NFC using NVC largely remains underutilised, mainly due to cost factors, lack of expertise and availability issues. Other instruments that have been utilised for NFC are a magnifying lens, an ophthalmoscope, a dermatoscope, a stereomicroscope and a wide field microscope. The aim of this article is to discuss the advantages and disadvantages of various instruments and techniques for NFC, with emphasis on our innovative techniques using a handheld microscope and a universal serial bus (USB) digital microscope.

by: Vivek Vasdev

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