Habit nail tic disorder: onychotillomania involving thumbs and toes responding to fluoxetine

Habit nail tic disorder is a type of nail dystrophy caused by repetitive trauma to the nail matrix. It is a body-focused repetitive behavior that is commonly reported among adults and may or may not be associated with obsessive-compulsive behavior. In this report, we present a case of a 12-year-old adolescent girl who had a central furrow with longitudinal ridges running parallel from the proximal to the distal end of both her thumbnails and toenails, giving them a "washboard" appearance and diagnosed as habit nail tic disorder, and treatment involved fluoxetine 20 mg and the application of permeable adhesive tape to protect the nails from external trauma. There was a positive response observed two months after the beginning of the treatment and the nail matrix resolved spontaneously.

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.

Two Cases of Onychotillomania / 대한피부과학회지

Onychotillomania, named by Alkiewicz, is a rare psychocutaneous disorder of the nails, and various psychological factors predispose the development of this condition. There has been no report of onychotillomania in Korea. We herein report two cases of onychotillomania seen in the nail clinic of our outpatient department. The first case was a 72 year old woman, who presented with a varying degree of dystrophic change to the first, second and third toenails on her right foot. She had a history of a depressive disorder and hypochondriasis. The second case was a 70 year old woman, who presented with complete destruction of the big toenail on her right foot, plus the 3rd and 4th fingernails of her right hand.