Nail tic disorders: Manifestations, pathogenesis and management.

Nail tic disorders are classic examples of overlap between the domains of dermatology and psychiatry. They are examples of body-focused repetitive behaviors in which there is an irresistible urge or impulse to perform a certain behavior. The behavior is reinforced as it results in some degree of relief and pleasure. Nail tic disorders are common, yet poorly studied and understood. The literature on nail tic disorders is relatively scarce. Common nail tics include nail biting or onychophagia, onychotillomania and the habit tic deformity. Some uncommon and rare nail tic disorders are onychoteiromania, onychotemnomania, onychodaknomania and bidet nails. Onychophagia is chronic nail biting behavior which usually starts during childhood. It is often regarded as a tension reducing measure. Onychotillomania is recurrent picking and manicuring of the fi ngernails and/or toenails. In severe cases, it may lead to onychoatrophy due to irreversible scarring of the nail matrix. Very often, they occur in psychologically normal children but may sometimes be associated with anxiety. In severe cases, onychotillomania may be an expression of obsessive-compulsive disorders. Management of nail tic disorders is challenging. Frequent applications of distasteful topical preparations on the nail and periungual skin can discourage patients from biting and chewing their fi ngernails. Habit-tic deformity can be helped by bandaging the digit daily with permeable adhesive tape. Fluoxetine in high doses can be helpful in interrupting these compulsive disorders in adults. For a complete diagnosis and accurate management, it is imperative to assess the patient’s mental health and simultaneously treat the underlying psychiatric comorbidity, if any.

Treatment of Extensive Phalangeal Osteomyelitis Due to Onychophagia: A Case Report

The onychophagia is a relatively common habitual behavior in children. Cosmetic problem is frequently involved, but it can lead to serious morbidity such as damage to nail, paronychia, secondary bacterial infections, dental problems and the phalangeal osteomyelitis. We report one case of surgically treated phalangeal osteomyelitis of distal interphalangeal joint of long finger using shortening procedure in an onychophagia patient.

A Clinical Study of 21 Cases of Washboard Nail / 대한피부과학회지

BACKGROUND: Washboard nail most commonly involves the thumbnail or great toenail. As its name implies, it resembles a washboard with a series of evenly spaced ridges across the nail. A central depression can be seen as well. This can develop as the result of repeated habitual trauma to the proximal nail fold by the other fingers or by biting the nailplate. Thus, it is also called habit tic deformity or traumatic nail dystrophy. Although it is known to be not uncommon, there have been no studies on this with a sufficient number of cases and long term follow up. OBJECTIVE: This study was conducted to provide a better understanding of washboard nail and to estimate the outcome of it. METHODS: We reviewed all the medical records and clinical photographs of 21 patients who had been diagnosed with washboard nail at our department between July 2000 and July 2009. RESULTS: The male to female ratio was 1:1.3. The patients' ages varied from 6 to 68 years, with an average of 25.4 years. The mean duration at the first visit was 4.4 years. The most common involved site was both thumbnails. Predisposing factors were found in 42.9% of the patients, which included nail picking or onychophagia. The treatment options were primarily intralesional triamcinolone injection and topical steroid. If the patient had the habitual tic, we educated them to restrain it. The follow up periods varied from 1 to 32 months with a mean of 7.9 months. Among the 14 patients with adequate follow up, 50% of these patients showed clinical improvement. CONCLUSION: This study demonstrated the clinical features of washboard nail. Physicians should closely observe the nail changes and long-term follow up is needed to determine the therapeutic response of patients with washboard nail.