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Introduction Microvascular abnormalities are an early manifestation in systemic sclerosis (SSc). Autologous hematopoietic stem cell transplantation (HSCT) has shown efficacy in severe diffuse forms, although its impact on microcirculation remains poorly documented. Our objective is to describe the clinical and capillaroscopic evolution in SSc patients treated with HSCT.Material and Methods We conducted a single-center, descriptive, longitudinal study in SSc patients undergoing HSCT. Clinical, therapeutic, and capillaroscopic data were collected before and after the procedure.Results Four female patients with diffuse SSc treated with HSCT were included.The median age at diagnosis was 40.5 years (SD 6.8), with a median interval from diagnosis to transplantation of 2.6 years (SD 0.9). The median follow-up time after HSCT was 6.5 years (SD 4.65).Clinical findings:All patients received cyclophosphamide and/or advanced therapy (Rituximab/Tocilizumab) before transplantation; three of them did not require further immunosuppressive therapy after HSCT.Three patients had vascular symptoms prior to HSCT, all of whom experienced clinical improvement post-transplant. The asymptomatic patient remained stable.Three patients had digital ulcers pre-HSCT. Post-HSCT, two of them did not develop further ulcers, and the other one showed improvement.All patients required vasodilator therapy before HSCT; after transplantation, only one patient continued to require it.Capillaroscopic findings:One patient showed a late pattern in a capillaroscopy performed one year before HSCT, which persisted unchanged one year after transplantation.Another patient maintained a nonspecific capillaroscopy pattern from one year pre-HSCT up to 11 years post-HSCT, with two follow-up capillaroscopies (at 5 and 11 years) showing improved capillary density and fewer dilations.A third patient showed progression from early to active pattern two months prior to HSCT. A capillaroscopy performed four years post-transplant revealed a late pattern.The fourth patient had no specific capillaroscopic abnormalities before HSCT, with no subsequent changes observed.Conclusions This case series showed a reduction in vascular symptoms, resolution or improvement of digital ulcers, and decreased need for vasodilator and immunosuppressive therapy in patients with diffuse SSc following HSCT. However, HSCT did not reverse structural microvascular damage in advanced stages.These findings suggest that HSCT may improve capillary microcirculatory function in SSc patients, although without reversing established structural damage.