Nailfold capillaroscopy (NFC) provides important clinical insights into disease pathobiology, diagnosis, and treatment response. As a clinical tool, this can be easily and rapidly performed in routine clinical practice at the ‘bedside’ and provides a novel non-invasive ‘window’ into the microcirculation. In patients presenting with Raynaud’s phenomenon, NFC is an essential diagnostic test, including to help inform risk stratification of progression to systemic sclerosis (SSc). Thermoregulatory testing (‘thermography’) is also very informative and provides complementary information to microvascular assessment by NFC. Herein, we present a diverse series of 5 clinical cases, including patients with juvenile SSc, in which NFC provided critical clinical insights and directly informed management. As clinicians, we provide a narrative discussion of each case to explain the diagnostic and management process, and how NFC was critical to achieving optimal outcomes.