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Dermatology Case Reports AL Hamzawi et al., Dermatol Case Rep 2018, 3:1
Case
Repot
Open Access
Tragic Teenage Boy Presenting With Calluses Due to Dermatophagia
Nabeel K. AL Hamzawi1* and Adil A. AL Zaidi2
1Department of Dermatology, Diwaniyah Teaching Hospital, Iraq
2Department of Psychiatric, Diwaniyah Teaching Hospital, Iraq
*Corresponding author: AL Hamzawi NK, Department of Dermatology, Diwaniyah Teaching Hospital, Iraq, E-mail: alhamzawi_n@yahoo.com
Received date: April 26, 2018; Accepted date: June 15, 2018; Published date: June 20, 2018
Copyright: ©2018 AL Hamzawi NK, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
Callus due to dermatophagia has rarely been reported in dermatology literature. Patients with this disorder
usually present with skin damage, bleeding, blistering and discoloration, especially around the fingernails. Moreover,
the presence of callus on the dorsum of proximal phalanges has also rarely described in the literature of PubMed,
Google Scholar and Research Gate.
We hereby describe a 16-year-old boy with bilateral calluses, on the dorsal aspects of the proximal phalanges of the
forefingers. General physical examination revealed that the patient had a mental illness and a habit of biting his
fingers at the affected sites for two years. We performed this report to emphasize the importance of the relationship
between dermatophagia and calluses presenting on the dorsum of the proximal phalanges of the fingers as calluses
are most often located on the feet and knuckles of the hands. Therefore, any patient experiencing a similar lesion to
the one in our case needs a proper history taken and assessment of mental state to exclude associated psychiatric
comorbidity.
Keywords: Callus; Dermatophagia; Obsessive-compulsive disorder;
Forefinger
Introduction
A callus is a localized, firm thickening of the outer layer of skin as a
result of repetitive friction or pressure. It is usually observed in areas
of skin such as the palms and soles that are subjected to continual
rubbing [1]. Dermatophagia is an obsessive-compulsive disorder,
wherein patients bite their skin around the nails in a hasty manner [2].
They also chewed inside the mouth, cheeks, and lips causing blisters in
and around the mouth [3]. Obsessive-compulsive disorder (OCD), a
common chronic condition, often associated with marked anxiety and
depression, characterized by "obsessions" and "compulsion."
Obsession and compulsion must cause distress or interfere with
personal social or individual functioning, and should not be the result
of another psychiatric disorder [4-7].
The patient feels relief after biting the skin for some before he or she
gets anxious again and starts to eat the skin back [8]. The clinical signs
of dermatophagia included skin damage, bleeding, infection, calluses,
and hangnails. Treatment consists of cognitive behavioral therapy and
medical treatment including antidepressant drugs [9]. Here we have
described a case of calluses on the hands associated with psychiatric
comorbidity needs to be explained in light of the previous literature.
Case Report: A 16- year-old boy brought by his family, to the
private medical clinic, where he had chronic, asymptomatic
hyperkeratotic plaques on both hands, which had slowly increased in
size, for one year. (Figures 1 and 2) No other skin lesions elsewhere
were present. There was no associated systemic symptoms nor was a
relevant family history. His family mentioned that his father was killed
by the militants of the Islamic state, in Mosul, a major city in northern
Iraq, two years ago. For this tragic event, the boy left school and his
mental state and behavior began to change. After a short period, he
began to bite his fingers harshly at the affected sites, and sometimes he
chewed them as an expression of his tense situation. Skin examination,
showed Welldefined bilateral plaques that were dark-brown in color,
measuring 1.5 cm in diameter, and were located on the extensor
surfaces of the proximal phalanges of the forefingers. On close
inspection using a magnifying lens, the lesion had a rough surface with
thick adherent brown scales. General physical examination showed
that the patient had a mental illness, with abnormal behavior, attitude,
and cognition. The diagnosis was calluses due to dermatophagia. The
lesions were treated with topical keratolytic and moisturizing ointment.
As the condition was a sign of obsessive-compulsive disorders, the
patient referred to the psychiatrist for assessment of his mental state,
psychiatric morbidity, treatment and follow up as a part of the
therapeutic team.
Citation: AL Hamzawi NK, AL Zaidi AA (2018) Tragic Teenage Boy Presenting With Calluses Due to Dermatophagia. Dermatol Case Rep 3:
140.
Dermatol Case Rep, an open access journal Volume 3 • Issue 1 • 1000140
Case Discussion dorsal aspects of the forefingers. They are bilateral and symmetrical in distribution. The boy had a mental illness and
problems related to his
We present a 16-year-old boy with calluses due to dermatophagia. behavior, mood, and cognition. We performed a literature search on The lesions
presented as hyperkeratotic, brown-colored plaques on the PubMed, Google Scholar, and Research Gate with the search term
Citation: AL Hamzawi NK, AL Zaidi AA (2018) Tragic Teenage Boy Presenting With Calluses Due to Dermatophagia. Dermatol Case Rep 3:
140.
Dermatol Case Rep, an open access journal Volume 3 • Issue 1 • 1000140
Figure 1: Bilateral calluses on the dorsal aspect of the forengers in a 16-year-old boy.
Figure 2: Close inspection using a magnifying lens showed a plaque with brownish hyperkeratotic scales.
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“callus and dermatophagia”. We found only one report with calluses on
the knuckles of both hands. The case was a teenage boy who had a
habit of intermittent biting of his knuckles. According to his father, the
boy’s behavior was normal and his school performance was
satisfactory [3].
Dermatophagia is the urge to bite the one’s own skin, most
commonly at the fingers and sometimes inside the mouth. The target
areas that usually attacked by the patient are the nail folds, hangnails
and cuticles as they can easily be destroyed by biting. Whether biting
and ingesting or only biting is a matter related to the severity of a
stressful situation of the patient and the presence of psychiatric
comorbidity. Biting and ingesting draw attention to severe reactions to
stressful states and are limited to the more easily damaged sites of the
skin such as around the nails, especially the nail spurs. Therefore,
biting and eating usually presented with ulceration, infection and even
bleeding. While in case of biting alone, the reaction is mild and the
patients preferred to choose other sites such as the dorsum of
phalanges and joints and in most, callus is the prominent sign. In the
current case, however, the patient repeatedly bites the dorsum of the
proximal phalanges of his forefingers. Still, there was no wound or
ulceration at the bitten site. The pathogenicity of callus, in this case,
was due to habitual biting (chronic friction) without ingestion, which
leads to accumulation of excess keratinous scales. This explained the
tense situation the patient had under certain circumstances, although,
he had an abnormal behavior and mental state. Through the follow-up,
the skin lesions improved after two weeks of treatment with topical
keratolytic, and regular visits to the psychiatrist are scheduled to treat
his mental illness.
Conclusion
The present case raises the suspicion of the relationship between
callus that occurs on the dorsum of the proximal phalanx of the
forefinger and dermatophagia. A proper history is required, and only
then should the patient referred to the psychiatrist for further
assessment of mental health problems.
References
1. Kim SH, Kim S, Choi HI, Choi YJ, Lee YS, et al. (2010) Callus
formation is associated with hyperproliferation and incomplete
differentiation of keratinocytes and increased expression of adhesion
molecules. Br.J Dermatol. 163: 495-501.
2. Grant JE, Mancebo MC, Eisen JL, Rasmussen SA. (2010) Impulse-
control disorders in children and adolescents with obsessive-compulsive
disorder. Psych Res. 175: 109-113.
3. Al Hawsawi K, Al Aboud K, Ramesh V. (2003) Dermatophagia
simulating callosities. Dermatology and Psychosomatics/Dermatologie
und Psychosomatik. 4: 42-43.
4. Semple D, Smyth R, (2013) Oxford handbook of psychiatry. OUP
Oxford.
5. Cowen P, Harrison P, Burns T. (2012) Shorter Oxford textbook of
psychiatry. Oxford University Press.
6. Kuhn H, Mennella C, Majid M, et al. (2017) Psychocutaneous disease. J
American Acad Dermato 76: 779-7791.
7. Jafferany M. (2007) Psychodermatology: a guide to understanding
common psychocutaneous disorders. Primary care companion to the J
Clin Psy 9: 203.
8. Pramod Kerkar (2016) What is dermatophagia, epain Assist Inc.
9. Morand-Beaulieu S, O’Connor KP, Richard M, Sauvé G, Leclerc JB, et
al. (2016) The impact of a cognitive–Behavioral Therapy on event-
related Potentials in Patients with Tic Disorders or Body-Focused
repetitive Behaviors. Front. Psychiatry 7: 81.
Dermatol Case Rep, an open access journal Volume 3 • Issue 1 • 1000140
