The NailFold Capillaries: Essential to Examine in Suspected Inflammatory Scalp Disease

The Nailfold Capillaries

For the hair dermatologist, the nails are important to examine when examining the patient. The shape and appearance of the nails are important and so are the nail folds -(the area where the nail first starts as one moves down from the knuckles towards the end of the finger). It is the appearance of the tiny blood vessels in the nail folds that are so important to examine in patients with suspected autoimmune disease.

Examination is done with a dermatoscope and the practice of doing this is simply referred to as “nail fold capillaroscopy.”

Normal Nailfold Capillary Arrangement (by dermoscopy)

This photo above shows the normal arrangement of these nail fold capillaries. They are all the same thickness and straight and lined up in a regular manner. Extremely important is the fact that none are missing. Dilation of these tiny capillaries and “dropout” whereby many start disappearing can be a sign of more serious underlying disease. Changes in the capillaries have been studied in detail in autoimmune diseases like dermatomyositis, psoriasis, lupus and scleroderma - and the precise appearance may help predict underlying organ disease. For example, in children with the skin disease dermatomyositis, reduced nailfold capillary density was associated with the children and teens having lung disease. In scleroderma, there is an association with lower capillary density and death. Other examples continue to be discovered.