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Onychotillomania is a psychodermatosis that results from self-induced repeated trauma to the nail unit. It is characterized by the neurotic and irresistible urge to pick at, pull out, or harmfully bite or injure the nail(s). Multiple psychological factors can be involved. It can be difficult to diagnose, as patients mostly deny the self-destructive...
Citations
... [8][9][10] Combining monthly intramatrical injections of triamcinolone acetonide with daily topical application of calcipotriol/betamethasone can effectively enhance the appearance of nails within eight months. 11 Nonpharmacological treatment has been reported in one patient with a significant decrease in nail-picking frequency after stimulus control and habit reversal training treatment. 12 Onychodystrophy is distinguished by irregular alterations in the shape, color, texture, and growth of nails. ...
Onychotillomania is characterized by an irresistible urge to pick or pull at one’s nails, resulting in significant damage to the nail and surrounding tissue. In severe cases, it can cause onychodystrophy, which leads to abnormal changes in nail shape, color, texture, and growth. Managing onychotillomania can be challenging due to the lack of standard treatment and concurrent behavioral disorders. Pharmacotherapy and behavioral therapy have shown some positive outcomes from reported cases. The treatment for onychodystrophy varies depending on the underlying cause and may entail the application of topical, systemic, or laser therapies. Nevertheless, there is currently no consensus on the most effective treatment approach. This report presents a case of onychodystrophy caused by onychotillomania successfully treated using a pulsed dye laser 595 nm. The treatment was administered four times, with a two-week interval between sessions. Significant improvement was seen within four weeks of starting the treatment, and by the end of the eight-week program, the dystrophic thumbnails had almost completely resolved. After a thorough ten-month follow-up, it has been determined that the dystrophic nails have not reappeared. Moreover, there has been a significant decrease in the patient’s tendency to pull her nails.
... Onychotillomania is an unusual and often misunderstood behavioral tendency that affects the nail apparatus. Patients are identified by an obsessive or irrepressible impulse to repeatedly damage their nails, either with their fingers or with other objects, resulting in obvious and even irreparable self-destruction of the nail unit [6]. A person with this impulse may be conscious or unconscious of its appearance [7,8]. ...
... Psychotherapy is also used and is mainly directed towards performing a competing response, such as gripping and pulling the hands [24], or acceptance-enhanced behavior therapy, including habit reversal and stimulus control. [25] The effectiveness of pharmacological treatments, consisting of the administration of various drugs such as N-acetylcysteine [26,27], intravenous triamcinolone acetonide followed by a topical combination of calcipotriol and betamethasone dipropionate [6], citalopram, and zolpidem hemitartrate [28], as well as behavioral treatment [25] have been reported for onychotillomania. ...
... Onychotillomania is an underestimated psychodermatosis caused by repetitive self-inflicted damage to the nail unit. The condition manifests with minor-to-severe nail plate morphologies [6]. It most often occurs in young people who are otherwise mentally normal, but it may also be related to anxiety in rare cases. ...
Background
Obsessive–compulsive disorder is a condition in which patients experience an obsession and/or a compulsion. It has a high impact on the quality of life, and is associated with an increased prevalence of psychiatric comorbidities in patients. Onychotillomania is an underestimated psychodermatosis caused by repeated self-inflicted damage to the nail unit. In patients, it is characterized by an obsessive or irrepressible impulse to repeatedly damage their own nails, resulting in their destruction. It is a chronic condition that is difficult to manage, largely because of its psychocutaneous character, as well as its high tendency to interact with underlying neuropsychiatric diseases or other behavioral disorders. Only a few studies have reported an association between obsessive–compulsive disorder and onychotillomania, which typically presents with therapeutic challenges. Cognitive behavioral therapy, physical-barrier approaches, and pharmaceutical treatments have been reported to be beneficial in the management of onychotillomania; however, no major clinical studies have investigated the effectiveness of these therapies. Onychotillomania remains a clinical and therapeutic issue owing to the lack of evidence-based treatment techniques.
Case presentation
We report a case of an 18-year-old, middle-eastern female patient who developed onychotillomania when she was being treated with paroxetine for obsessive–compulsive disorder and was showing partial improvement. The patient developed side effects from paroxetine, and was switched to fluoxetine. Thereafter, improvement in her obsessive–compulsive disorder was observed, which relapsed when treatment was discontinued. However, the onychotillomania symptoms did not reemerge.
Conclusion
Onychotillomania typically presents both diagnostic and therapeutic challenges. Fluoxetine plays an important role in the treatment of onychotillomania and other psychiatric disorders. However, large-scale studies should be conducted before these outcomes can be generalized.
... Psychiatric disorders are often comorbid with onychotillomania, namely depression, anxiety, and psychosis. In 29 onychotillomania cases, eight were associated with depression with or without psychosis [48][49][50][51][52][53][54], four with general anxiety disorder, adjustment disorder, or specific phobias [2,55,56], and two with psychosis and hypochondrial delusions [57,58]. In one case, there were no psychiatric comorbidities, and for the remaining 14 cases no psychiatric evaluations were performed [59][60][61][62][63]. ...
... In one case report, a 19-year-old woman with onychotillomania was treated with monthly intramatrical nail injections of triamcinolone acetonide (0.2 mL of 5 mg/mL) for 3 months, followed by bimonthly injections for 6 months and daily topical calcipotriol/ betamethasone dipropionate. Nail appearance improved after three months, with completely normal nail folds, cuticles, and nail plates by eight months [55]. ...
Onychophagia (nail biting) and onychotillomania (nail picking) are chronic nail conditions categorized as body-focused repetitive behavior (BFRB) disorders. Due to a limited awareness of their clinical presentations, embarrassment on the part of patients, and/or comorbid psychiatric conditions, these conditions are frequently underrecognized and misdiagnosed. This article reviews the prevalence, etiology, diagnostic criteria, historical and physical exam findings, and treatment options for these conditions. The PubMed/MEDLINE database was searched for relevant articles. Onychophagia and onychotillomania are complex disorders necessitating a detailed patient history and physical examination and a multidisciplinary treatment approach for successful diagnosis and management. Due to the dearth of clinical trials for treatment of nail biting and nail picking, large clinical trials are necessary to establish standardized therapies.
... As a result, much of the treatment is dispensed on a case-by-case basis. Certain pharmacologic treatments such as topical steroids can help in achieving clinical success with respect to reversing nail changes [16]. However, our patient's lack of health insurance, decreased ability to attend follow-up appointments, aversion to medications, and lack of appropriate storage for medications meant that pharmacologic therapy was not optimal for this case. ...
Onychotillomania is a psychodermatosis that involves repetitive, self-induced trauma to the nail and sometimes the periungual skin. It is generally seen as an overlapping psychiatric and dermatologic disorder, although there have not been any statistically significant associations with psychiatric illness. Some studies have noted an association with obsessive-compulsive disorder (OCD). Due to the relative lack of empirical data on this condition, treatments are often not evidence-based. As a result, there is no standardized method of treating onychotillomania, and patients suffering from this disease are susceptible to relapse. This report presents the case of a 32-year-old male experiencing homelessness and suffering from major depressive disorder and methamphetamine use disorder who developed onychotillomania two months after becoming homeless. He regularly used various instruments such as nail cutters, tweezers, and nail files to constantly pick at his nails, a few of which were noted to be bleeding with signs of infection. He was evaluated jointly by dermatology and psychiatry providers who confirmed the diagnosis. By thorough examination of the patient's history, he was provided tactile sensory equipment to reduce his repetitive picking behavior. A direct referral for substance use counseling was also provided. At follow-up, he was noted to have a subjective improvement in his picking symptoms, although there was no significant difference in the size of his nails. This case represents the twofold challenge of managing a difficult condition, onychotillomania, in the setting of the severe socio-personal stressor of homelessness.
Onychotillomania, also known as “nail picking,” describes self-induced trauma to the fingernails or toenails and periungual skin using one’s own fingers or other tools, including knives, scissors, or toothpicks, and is classified as a body-focused repetitive behavior [1–3]. Patients with onychotillomania may pick or excessively manicure their nails, resulting in onychodystrophy and other complications, including paronychia [3]. Onychotillomania is commonly seen in clinical practice, but prevalence estimates vary widely, suggesting that it is underreported. In a cross-sectional survey-based study by Pacan et al. examining the prevalence of onychotillomania and onychophagia in 339 Polish medical students, the estimated prevalence of onychotillomania was 0.9% [1, 4], In a cross-sectional survey study of 181 graduate students by Wu et al., 46.4% of respondents (84/181) reported nail picking [5].
Nail is a hard cutaneous structure; however, it is susceptible to external and self-induced injury that can lead to alterations in morphology. Self-induced nail disorders are a group of varied clinical manifestations that are caused by the patient voluntarily. They are classified as body-focused repetitive behaviour disorders (BFRBs). Common habits that lead to nail changes but are not associated with overt psychological abnormalities include onycholysis semilunaris, habit tic and onychophagia. The other major class includes nail disorders associated with psychiatric diseases, for example, onychodaknomania. These disorders often mimic a variety of nail conditions. Patients may not present to clinicians with these disorders as the primary complaint. An underlying psychiatric or psychological condition is often found, especially in adults. Hence, clinicians need to be aware of this clinical entity to be able to offer correct diagnosis and appropriate management. Multidisciplinary management is suggested, involving both non-pharmacological and pharmacological approaches. Behavioural interventions such as habit reversal therapy have a role in management. This article is aimed at analysing and presenting literature about these nail disorders to raise awareness. It discusses in detail various clinical entities, pathomechanisms, associated disorders and management.
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