In the Toolbox: The Dual Action Nail Clipper

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Conditions affecting the nail may have similar clinical morphologies and are often challenging to diagnose. The diagnostic gold standard is a biopsy of the nail matrix or nail bed with histopathological analysis. However, there are barriers to performing a nail biopsy (education and experience) and small but significant risks associated with the procedure (infection, bleeding, and nail dystrophy). However, nail clipping is a simple noninvasive procedure that can be used both for diagnostic and therapeutic purposes. Nail clipping combined with histopathological examination can be used to diagnose a wide range of nail conditions, including onychomycosis, psoriasis, hematoma, onychomatricoma, lichen planus, and onychopapilloma.1 It can also be used to thin down thickened nails to allow better efficacy of medications.
Although nails 1 mm in thickness can be clipped easily with a traditional nail clipper, it is particularly challenging for the dermatologist and painful for the patient to obtain a sufficient sample with thick hyperkeratotic nails. Obtaining a tissue sample that is too small is the most common error physicians make when performing a nail clipping.
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