Onychotillomania: Diagnosis and Management

Abstract

Onychotillomania, defined as self-induced trauma to the nail unit, either by picking or pulling at the nails, affects 0.9% of the population. It may lead to severe irreversible nail dystrophy, melanonychia, or infections. Although no large clinical trials have assessed the efficacy of treatments, cognitive-behavioral therapy, physical barrier methods, and pharmacological treatments have shown some benefits in case reports. The objective of this article is to review the prevalence, diagnostic criteria, etiology, historical and physical examination findings, pathological features, and current treatment methods. Onychotillomania remains a clinical challenge to dermatologists, pediatricians, internists, and psychiatrists in practice, as there are no evidence-based treatment methods.

Onychotillomania: A Chameleon-Like Disorder: Case Report and Review of Literature

“…Despite the scarcity of data regarding the efficacy of treatment strategies, unpleasant-flavored topical agents and nail lacquers, physical barrier methods, cognitive-behavioral therapy, and psychopharmacological interventions have shown varying, yet encouraging therapeutic benefits [1,2,10,11]. One of the most commonly used practice is occlusion of the nails from trauma by placing a barrier between the mouth and fingers, e.g., occlusive dressings such as gloves, Unna boot, bandages, and wrappings with adhesive tape [3,5,10].…”

“…One of the most commonly used practice is occlusion of the nails from trauma by placing a barrier between the mouth and fingers, e.g., occlusive dressings such as gloves, Unna boot, bandages, and wrappings with adhesive tape [3,5,10]. Our approach was to apply daily an occlusive bandage wrapping the fingernail and refer the patient to a psychiatrist for consultation and psychoactive medication after uncovering the concomitant psychopathology.…”

Marvelous Response of Severe Onychotillomania to Treatment with Local Steroid Injection plus Topical Calcipotriol/Betamethasone Dipropionate Combination

“…Frequent applications of distasteful topical preparations on the nail and periungual skin aiming to discourage patients from biting and chewing their fingernails [6] are employed. A common practice is occlusion of the nails from trauma by placing a barrier between the mouth and fingers; e.g., occlusive dressings such as gloves, bandages, and wrappings with adhesive tape [5]. This is applicable, to a large extent, to children but may be unsuitable for older patients.…”

“…Although no large clinical trials have assessed the efficacy of treatments, cognitive-behavioral therapy, physical-barrier methods, and pharmacological treatments have shown some benefits in case reports. Onychotillomania remains a clinical and therapeutic challenge to dermatologists, pediatricians, internists, and psychiatrists in practice, as there are no evidence-based treatment methods [5].…”

Comment on “Psychocutaneous disease: Clinical perspectives”

“…A characteristic finding is a median longitudinal groove with parallel transverse grooves, known as habit-tic deformity (Fig 1). 3 Onychophagia, defined as chronic nail biting, is a common disorder affecting up to 30% of the general population, including both children and adults. This disorder has been associated with anxiety and obsessive-compulsive disorders.…”