This case report explores an 18-year-old female patient undergoing lithium therapy for bipolar disorder over four years, combined with a concurrent two-year history of smoking approximately 20 cigarettes daily. Over the past year, the patient exhibited acrocyanosis primarily affecting her hands, particularly following cold exposure. Capillaroscopic analysis in November 2024 revealed a "scleroderma-like pattern," marked by megacapillaries, architectural disorganization, and microhemorrhages. Comprehensive immunological testing, including antinuclear antibodies (ANA), anti-cardiolipin antibodies, and anti-phospholipid antibodies, returned negative results, with no clinical or laboratory evidence indicative of an underlying connective tissue disease (CTD). This case underscores the interplay of environmental and pharmacological contributors, such as smoking and lithium, to microvascular dysfunction, emphasizing the necessity of rigorous diagnostic assessments and mitigation of modifiable risk factors in patient care.