Nailfold capillaroscopy (NVC) is a simple, non-invasive, inexpensive and useful method for the analysis of microvascular abnormalities found in several rheumatic disorders. The well-known Raynaud's phenomenon is a clinical condition that should promptly lead to a microvascular analysis, in order to distinguish its primary form (functional, not disease associated) from the secondary Raynaud's phenomenon (disease associated). NVC has an exceptional predictive value in this early distinction, and this may be the best advantage this technique can offer. Microvascular damage is a typical feature of Systemic Sclerosis (SSc) and more than 95% of the patients present architectural disorganization, giant capillaries, haemorrhages, loss of capillaries, avascular areas and neovascularization, as main microvascular abnormalities. These sequential capillaroscopic changes characterize the "scleroderma pattern" and reflect the SSc microangiopathy. In dermatomyositis and undifferentiated connective tissue disease the capillaroscopic aspects are generally named as "scleroderma-like pattern". Capillaroscopy changes have also been found in other systemic rheumatic diseases such as Systemic Lupus Erythematosus, Antiphospholipid Syndrome and Sjögren's Syndrome, further epidemiological and clinical studies are needed to better characterize and standardize nailfold capillaroscopy patterns in these disorders.