New Tools in Nail Disorders

Tumors of the nail unit may be difficult to diagnose because of the screening effect of the
nail plate. In longitudinal melanonychia, several new promising techniques assist with early
diagnosis of melanoma (in vivo matrix dermoscopy and immunohistochemistry) as well as
sparing as much of the healthy tissues as is possible (shave biopsy technique). Diagnosing
nail disorders is in some instances difficult both for the clinician and the pathologist. New
tools such as polymerase chain reaction have been proposed for onychomycosis, which
accounts for more than half of nail conditions, will allow quick and accurate diagnosis.
However, polymerase chain reaction analysis remains expensive and is not routinely used
by clinicians. Scoring nail dystrophy by clinical observation remains very subjective;
therefore, severity indexes have been proposed. Another emerging noninvasive technique
is forensic analysis of nail clippings for detection of drug intake and abuse, as well as
exposure to environmental pollution