1
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Pacifico A, Iorizzo M, Pasch M, Kridin K, Del Fabbro M, Mercuri SR, Peluso L, Damiani G. Telemedicine in Nail Psoriasis: Validation of a New Tool to Monitor (In-Person, In-Picture, and In-Video) Nail Psoriasis Severity in Patients with Concurrent Onychophagia and Onychotillomania. Dermatol Ther (Heidelb) 2024; 14:1161-1172. [PMID: 38700647 PMCID: PMC11116310 DOI: 10.1007/s13555-024-01160-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 04/04/2024] [Indexed: 05/24/2024] Open
Abstract
INTRODUCTION Since during the COVID-19 pandemic nail psoriasis was evaluated exclusively with teledermatology, dermatologists started to face the difficulty in rating it concurrent with other onycopathies (i.e., onychotillomania and onychophagy). Thus, we aimed to improve the existing severity scores and verify the value in different clinical settings (i.e., in person vs. teledermatology (video or picture)). METHODS This multicenter prospective observational study evaluated patients with nail psoriasis and screened them for onychophagy or onychotillomania in telemedicine from May 2020 to January 2021. For therapeutic purposes patients with nail psoriasis were followed and rated with the Nijmegen-Nail psoriasis Activity Index tooL (N-NAIL) for 9 months; at the same time, N-NAIL and a new dedicated index that monitor also the changes in nail dimension (Galeazzi-(G) N-NAIL) were tested for accuracy. We assessed inter- and intraobserver agreement for the three different settings (in person, video, and pictures). RESULTS In our cohort of 382 patients with nail psoriasis after a clinical and dermatoscopic assessment we found 20 (5.24%) patients with onychophagy and 17 (4.45%) patients with onychotillomania. Analysis of the impact of nail psoriasis on patients revealed that onycholysis and crumbing, followed by subungual hyperkeratosis, were the clinical signs that prevalently bothered patients. N-NAIL score displayed moderate intra- and interobserver agreement. Over the 9 months follow-up, N-NAIL vs. GN-NAIL displayed a solid correlation at all the examined time points, i.e., baseline and after 3, 6, and 9 months. CONCLUSION We created a new tool, the GN-NAIL capable of efficiently scoring nail psoriasis severity in complex cases, such as patients with onychotillomania and onychophagy, and monitor response to treatment during the COVID-19 pandemic.
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Affiliation(s)
- Alessia Pacifico
- Clinical Dermatology Department, IRCCS S. Gallicano Dermatological Institute, 00144, Rome, Italy
| | | | - Marcel Pasch
- Department of Dermatology, Radboud University Medical Center, 6525, Nijmegen, The Netherlands
| | - Khalaf Kridin
- Lübeck Institute of Experimental Dermatology, University of Lübeck, 23538, Lübeck, Germany
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122, Milan, Italy
| | - Santo R Mercuri
- Unit of Dermatology, IRCCS San Raffaele Hospital, 20132, Milan, Italy
| | - Lorenzo Peluso
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, 1050, Brussels, Belgium
| | - Giovanni Damiani
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122, Milan, Italy.
- Clinical Dermatology, IRCCS Ospedale Galeazzi-Sant'Ambrogio, 20161, Milan, Italy.
- Italian Center of Precision Medicine and Chronic Inflammation, Via Della Commenda 10, 20122, Milan, Italy.
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2
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Starace M, Cedirian S, Alessandrini A, Bruni F, Piraccini BM, Iorizzo M. Self-induced nail disorders (SINDs): What do we know so far? Ann Dermatol Venereol 2023; 150:253-259. [PMID: 37813711 DOI: 10.1016/j.annder.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/17/2023] [Accepted: 05/09/2023] [Indexed: 10/11/2023]
Abstract
Self-induced nail disorders are a broad group of different clinical manifestations that share the common trait of being caused more or less voluntarily by the patient. These are distinct conditions within the clinical spectrum of onychotillomania. Most patients diagnosed with these disorders have psychiatric co-morbidities, and a multidisciplinary approach is thus highly recommended. The purpose of this review is to describe the most common clinical features encountered during daily nail consultations and to provide useful diagnostic tools and therapeutic tips for the best approach to these conditions.
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Affiliation(s)
- M Starace
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater Studiorum University, Bologna, Italy
| | - S Cedirian
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater Studiorum University, Bologna, Italy.
| | - A Alessandrini
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater Studiorum University, Bologna, Italy
| | - F Bruni
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater Studiorum University, Bologna, Italy
| | - B M Piraccini
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater Studiorum University, Bologna, Italy
| | - M Iorizzo
- Private Dermatology Practice, Lugano/Bellinzona, Switzerland
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3
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Paichitrojjana A. Successful Treatment of Dystrophic Nails Caused by Onychotillomania Using Pulsed Dye Laser 595 nm: A Case Report. Clin Cosmet Investig Dermatol 2023; 16:2931-2936. [PMID: 37873512 PMCID: PMC10590586 DOI: 10.2147/ccid.s434472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/13/2023] [Indexed: 10/25/2023]
Abstract
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.
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Affiliation(s)
- Anon Paichitrojjana
- School of Anti-Aging and Regenerative Medicine, Mae Fah Luang University, Bangkok, Thailand
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4
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Case Study. JOURNAL OF THE DERMATOLOGY NURSES' ASSOCIATION 2023. [DOI: 10.1097/jdn.0000000000000727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
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5
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Bonamonte D, Foti C, DE Marco A, Hansel K, Cecchini E, Filoni A, DE Prezzo S, Ambrogio F, Angelini G, Stingeni L. Self-inflicted pathological cutaneous disorders. Part II. Ital J Dermatol Venerol 2022; 157:480-488. [PMID: 36177780 DOI: 10.23736/s2784-8671.22.07376-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Self-inflicted skin disorders are artefact diseases inflicted by the use of multiple different means, for various different purposes. They account for about 2% of dermatology patient visits, and include disorders with a denied or hidden pathological behavior (factitious disorders) and disorders with a non-denied and non-hidden pathological behavior (compulsive disorders). In turn, factitious skin disorders are subdivided into 2 groups: factitious disorders without an external incentive (considered in a preceding work) and factitious disorders with external incentives. In the second eventuality, the simulator is motivated by illicit intent, wishing to evade civil duties or a prison sentence, for instance, or to exploit situations of an occupational nature, and is fully aware of his action and his intention. Apart of the two groups of pathomimic artefacts and malingering, some self-inflicted dermatoses are due to behavioral disorders involving compulsive habits (tics, psychological excoriations). The great majority of subjects suffering from the latter disturbances are quick to confess their urge to self-inflict lesions. The management, including both psychiatric and dermatological assessment, concludes this second part of the work regarding the self-inflicted cutaneous diseases.
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Affiliation(s)
- Domenico Bonamonte
- Section of Dermatology, Department of Biomedical Science and Human Oncology, Aldo Moro University, Bari, Italy -
| | - Caterina Foti
- Section of Dermatology, Department of Biomedical Science and Human Oncology, Aldo Moro University, Bari, Italy
| | - Aurora DE Marco
- Section of Dermatology, Department of Biomedical Science and Human Oncology, Aldo Moro University, Bari, Italy
| | - Katharina Hansel
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Elisa Cecchini
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Angela Filoni
- Section of Dermatology, Perrino Hospital, Brindisi, Italy
| | - Serena DE Prezzo
- Section of Dermatology, Department of Biomedical Science and Human Oncology, Aldo Moro University, Bari, Italy
| | - Francesca Ambrogio
- Section of Dermatology, Department of Biomedical Science and Human Oncology, Aldo Moro University, Bari, Italy
| | - Gianni Angelini
- Section of Dermatology, Department of Biomedical Science and Human Oncology, Aldo Moro University, Bari, Italy
| | - Luca Stingeni
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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Aljhani S. Fluoxetine for the treatment of onychotillomania associated with obsessive–compulsive disorder: a case report. J Med Case Rep 2022; 16:431. [DOI: 10.1186/s13256-022-03652-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/14/2022] [Indexed: 11/21/2022] Open
Abstract
Abstract
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.
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7
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Nguyen B, Hawash AA, Tosti A. Oral N-acetylcysteine in the Treatment of Onychotillomania. Dermatol Ther 2022; 35:e15605. [PMID: 35620921 DOI: 10.1111/dth.15605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/25/2022] [Accepted: 05/25/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Betty Nguyen
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.,University of California Riverside School of Medicine, Riverside, CA, USA
| | - Ahmed A Hawash
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Antonella Tosti
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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8
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Cohen PR, Kurzrock R. Nailing the Diagnosis: Onychotillomania in Patients With Artificial Nails—An Underrecognized Phenomenon? Cureus 2022; 14:e24737. [PMID: 35686271 PMCID: PMC9170376 DOI: 10.7759/cureus.24737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 11/25/2022] Open
Abstract
Artificial nails are an essential component of nail cosmetics. The artificial nails are either preformed and glued onto the existing nail plate or they are custom made by applying a polymerizing mixture to the existing nail plate and overlying the template with a paintbrush that is subsequently allowed to harden into an acrylic nail. Artificial nails require regular maintenance. Onychotillomania is a body-focused repetitive disorder in which the person is usually aware that they are picking at their nail and/or the surrounding soft tissue. A woman with onychotillomania affecting her artificial nails is described; although this may be a relatively common occurrence, additional reports of artificial nail-associated onychotillomania were not able to be retrieved from the medical literature. The woman was not only aware that she picked at her artificial nails, but also realized that the action might result in adverse events to her natural nails and the corresponding digits. She desired no interventions for her nail-associated repetitive behavior and continued to regularly visit the nail salon for the application of new artificial custom acrylic nails. The acronym ANASON is introduced to define the condition of artificial nail-associated onychotillomania.
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9
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Update on Diagnosis and Management of Onychophagia and Onychotillomania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063392. [PMID: 35329078 PMCID: PMC8953487 DOI: 10.3390/ijerph19063392] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/07/2022] [Accepted: 03/11/2022] [Indexed: 12/16/2022]
Abstract
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.
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10
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Rasul TF, Gulraiz S, Henderson A. Onychotillomania in the Setting of Homelessness. Cureus 2022; 14:e22988. [PMID: 35415028 PMCID: PMC8993992 DOI: 10.7759/cureus.22988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2022] [Indexed: 11/16/2022] Open
Abstract
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.
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11
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Cohen PR. Nail-Associated Body-Focused Repetitive Behaviors: Habit-Tic Nail Deformity, Onychophagia, and Onychotillomania. Cureus 2022; 14:e22818. [PMID: 35382180 PMCID: PMC8976532 DOI: 10.7759/cureus.22818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2022] [Indexed: 11/05/2022] Open
Abstract
Habit-tic nail deformity, onychophagia (also referred to as nail biting) and onychotillomania (also referred to as nail picking) are body-focused repetitive behaviors that can involve the nails and periungual skin. Patients with habit-tic nail deformity are typically unaware that repeatedly using their nail, often the adjacent index finger, to rub the proximal nail fold and its underlying matrix - usually of one or both of their thumbnails - is the cause of the longitudinal depressed groove that extends along the entire the nail plate. Nail biters usually bite multiple nails - most commonly on the digits of the hands - and the patient is cognizant of their behavior. However, the term onychophagia is a misnomer and onychodaxia would be a more appropriate nomenclature. Nail pickers also often realize that their dystrophic nail results from using other nails or tools to pick, pull, or excessively manicure the affected nail. Individuals with habit-tic nail deformity or onychophagia or onychotillomania may concurrently have other repetitive behaviors involving the skin or the hair or both. Three patients with a nail-associated body-focused repetitive behavior are described who not only presented with dystrophy of their nails but also abnormalities of the adjacent nail apparatus: a 36-year-old woman with habit-tic nail deformity and dermatodaxia, a 64-year-old man with biting of both the nails and the skin, and a 63-year-old man with nail picking and skin picking. The nail dystrophy and concurrent skin biting or skin picking were not the issues that prompted the reported patients to seek evaluation by a physician; the body-focused repetitive behaviors of the nails and skin were incidental findings during their cutaneous examination. The management of nail-associated body-focused repetitive behavior may include non-pharmacologic treatments (such as physical modalities and behavior modifications) and/or pharmacologic agents. The reported woman with habit-tic nail deformity was willing to consider an attempt to modify her repetitive behavior by using paper tape as a physical modality to cover the area on her thumbs that she would unconsciously rub. However, similar to the men in this report with onychophagia and onychotillomania, many of the patients with nail-focused repetitive behaviors do not want to initiate any interventions that might decrease or eliminate their nail condition.
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12
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Chen Y, Pradhan S, Lyu L, Xue S. Clinical and Dermoscopic Characteristics of Onychophagia and Onychotillomania: A Retrospective Study of 63 Cases. Clin Exp Dermatol 2021; 47:961-963. [PMID: 34905226 DOI: 10.1111/ced.15057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/08/2021] [Accepted: 12/09/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Yusha Chen
- Department of Dermatology, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Sushmita Pradhan
- Department of Dermatology, Sichuan University West China Hospital, Chengdu, Sichuan, China.,Department of Dermatology, Province Hospital, Karnali province, Birendranagar Surkhet, Nepal
| | - Ling Lyu
- Department of Dermatology, Aerospace central hospital, Beijing, China
| | - Siliang Xue
- Department of Dermatology, Sichuan University West China Hospital, Chengdu, Sichuan, China
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13
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Dany M, Fischer AS, Pei S, Rubin AI. Updates on the Pathology and Management of Nail Unit Tumors and Dermatoses. Surg Pathol Clin 2021; 14:327-339. [PMID: 34023109 DOI: 10.1016/j.path.2021.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Nail unit pathology is indispensable to reach an accurate diagnosis of nail tumors as well as inflammatory disorders. This review article provides an update from the most recently published studies on the pathology and management of nail unit tumors and inflammatory disorders. Recent findings of nail clipping histopathology are described first, followed by discussing recent data on the diagnosis and surgical management of several types of nail unit tumors, ending with discussing the recent discoveries in selected nail unit inflammatory disorders.
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Affiliation(s)
- Mohammed Dany
- Department of Dermatology, Hospital of the University of Pennsylvania, University of Pennsylvania, 3600 Spruce Street, 2 Maloney Building, Philadelphia, PA 10104, USA
| | - Andrew S Fischer
- Department of Dermatology, Hospital of the University of Pennsylvania, University of Pennsylvania, 3600 Spruce Street, 2 Maloney Building, Philadelphia, PA 10104, USA
| | - Susan Pei
- Department of Dermatology, Hospital of the University of Pennsylvania, University of Pennsylvania, 3600 Spruce Street, 2 Maloney Building, Philadelphia, PA 10104, USA
| | - Adam I Rubin
- Department of Dermatology, Hospital of the University of Pennsylvania, University of Pennsylvania, 3600 Spruce Street, 2 Maloney Building, Philadelphia, PA 10104, USA; Hospital of the University of Pennsylvania, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, University of Pennsylvania, 3600 Spruce Street, 2 Maloney Building, Philadelphia, PA 10104, USA.
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14
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Gopinath H, Karthikeyan K. Neem in dermatology: Shedding light on the traditional panacea. Indian J Dermatol 2021; 66:706. [PMID: 35283494 PMCID: PMC8906293 DOI: 10.4103/ijd.ijd_562_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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15
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Wu AG, Lin K, Cooley V, Lipner SR. A cross-sectional study of onychotillomania and onychophagia in graduate students. Dermatol Ther 2020; 34:e14639. [PMID: 33314596 DOI: 10.1111/dth.14639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/25/2020] [Accepted: 12/01/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Albert G Wu
- New York Medical College, Valhalla, New York, USA
| | - Krysta Lin
- Paul L. Foster School of Medicine, El Paso, Texas, USA
| | - Victoria Cooley
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY, USA
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, NY, USA
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Yalçın M, Baş A, Ergelen M, Gökçe E, Usta Sağlam NG, Öcek Baş T, Gıynaş FF. Psychiatric comorbidity and
temperament‐character
traits of the patients with lichen simplex chronicus: The relation with the symptom severity of the disease. Dermatol Ther 2020; 33:e14389. [DOI: 10.1111/dth.14389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/03/2020] [Accepted: 10/06/2020] [Indexed: 01/24/2023]
Affiliation(s)
- Murat Yalçın
- University of Health Sciences Erenköy Training and Research Hospital for Psychiatry and Neurological Diseases, Psychiatry Istanbul Turkey
| | - Alper Baş
- University of Health Sciences Erenköy Training and Research Hospital for Psychiatry and Neurological Diseases, Psychiatry Istanbul Turkey
| | - Mine Ergelen
- University of Health Sciences Erenköy Training and Research Hospital for Psychiatry and Neurological Diseases, Psychiatry Istanbul Turkey
| | - Elif Gökçe
- University of Health Sciences Istanbul Kartal Lutfi Kirdar Training and Research Hospital, Dermatology Istanbul Turkey
| | - Nazife Gamze Usta Sağlam
- University of Health Sciences Erenköy Training and Research Hospital for Psychiatry and Neurological Diseases, Psychiatry Istanbul Turkey
| | - Tuba Öcek Baş
- University of Health Sciences Erenköy Training and Research Hospital for Psychiatry and Neurological Diseases, Psychiatry Istanbul Turkey
| | - Fikret Ferzan Gıynaş
- University of Health Sciences Erenköy Training and Research Hospital for Psychiatry and Neurological Diseases, Psychiatry Istanbul Turkey
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17
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Abdo HM. Marvelous Response of Severe Onychotillomania to Treatment with Local Steroid Injection plus Topical Calcipotriol/Betamethasone Dipropionate Combination. Skin Appendage Disord 2020; 6:158-161. [PMID: 32656235 DOI: 10.1159/000506139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 01/23/2020] [Indexed: 11/19/2022] Open
Abstract
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 behavior, and the clinical features may mimic other inflammatory conditions of the nail apparatus. It presents with typical, usually bizarre morphologies of the nail plate. There is no evidence-based treatment for the condition, and it can be highly resistant to both dermatological and psychological interventions. Based on history and classical nail changes, a case of onychotillomania in a 19-year-old woman successfully treated with local steroid injection plus topical calcipotriol/betamethasone dipropionate combination is presented. An injection of a local steroid (0.2 mL of 5 mg/mL triamcinolone acetonide) was given monthly for 3 months and was then decreased to a bimonthly interval. In addition, topical calcipotriol/betamethasone dipropionate combination was applied daily for 3 months and was then decreased to every other day. Clinical improvement was noted after the third month, while complete resolution of the condition was achieved after 8 months. This treatment regimen can be advocated for similar nail dystrophies after excluding infective etiology.
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Affiliation(s)
- Hamed Mohamed Abdo
- Department of Dermatology, Faculty of Medicine, Al Azhar University, Cairo, Egypt
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Abstract
Various advancements in the diagnosis and management of nail diseases have transpired in recent years. To provide the best care for patients with nail complaints, it is essential that physicians be updated on new diagnostic and treatment modalities. The purpose of this article is to discuss new and oncoming diagnostic and management options for nail disorders, including nail psoriasis, retronychia, brittle nails, onychotillomania, trauma, trachyonychia, and pyogenic granulomas.
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Solley K, Turner C. Prevalence and correlates of clinically significant body-focused repetitive behaviors in a non-clinical sample. Compr Psychiatry 2018; 86:9-18. [PMID: 30041079 DOI: 10.1016/j.comppsych.2018.06.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 06/19/2018] [Accepted: 06/20/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Body-focused repetitive behaviors (BFRBs) are repetitive, ritualized behaviors focused on the body, involving compulsively damaging one's physical appearance or causing physical injury. They include skin picking, hair pulling, nail biting, and lip or cheek biting and chewing. This study sought to examine prevalence, clinical correlates and quality of life (QoL) impairment associated with these conditions in a non-clinical sample of adults. METHOD An online survey was completed by N = 1378 participants. Comparisons were made between those self-reporting body-focused repetitive behavior to those without, on a range of clinical correlates (depression, anxiety, obsessive-compulsive symptoms, body dysmorphic symptoms, fear of negative evaluation) and QoL domains. RESULTS Three-hundred and eighteen participants (23%) reported the presence of a probable BFRB; n = 85 (6%) nail biting, n = 88 (6%) lip or cheek biting/chewing, n = 187 (14%) skin picking, and n = 39 (2%) hair pulling. There were significant differences between those with and without a probable BFRB (pBFRB) across all clinical variables investigated, with the pBFRB group reporting higher levels of symptoms. The BFRB group reported reduced QoL on some domains. Few differences emerged between the BFRB groups, although individuals with probable skin picking reported higher levels of body image concern, than those with other pBFRB conditions, and there was a trend toward probable skin picking to endorse higher levels of OCD symptoms and anxiety. There were no significant differences between the BFRB groups on QoL domains. CONCLUSION Although differences were found between those with a pBFRB and those without, there were few differences between the different pBFRB groups, indicating that all BFRB conditions are concerning. Skin picking may be one of the more severe of the BFRB presentations, although the small number of differences between the groups may reflect a single pathological grooming factor underlying the BFRBs. These findings underscore the importance of recognizing that all body-focused behaviors can cause significant distress, impairment, and reduced QoL, and highlights the need for timely and accurate identification of these conditions by health professionals.
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Affiliation(s)
- Katelyn Solley
- School of Psychology, The University of Queensland, Australia
| | - Cynthia Turner
- School of Psychology, The University of Queensland, Australia; School of Psychology, Australian Catholic University, Brisbane, Australia.
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Dermoscopic features of onychotillomania: A study of 36 cases. J Am Acad Dermatol 2018; 79:702-705. [DOI: 10.1016/j.jaad.2018.04.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/03/2018] [Accepted: 04/09/2018] [Indexed: 11/23/2022]
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Gür K, Erol S, İncir N. The effectiveness of a nail-biting prevention program among primary school students. J SPEC PEDIATR NURS 2018; 23:e12219. [PMID: 29797491 DOI: 10.1111/jspn.12219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 04/09/2018] [Accepted: 04/27/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE This study aimed to demonstrate the effect of a program called "Do Not Bite Your Nails, Cut Your Nails," which is based on a health promotion model to change the nail-biting habit among primary school students. DESIGN AND METHODS This quasi-experimental study was conducted using the pre- and post-test and interrupted time series design. The study sample included 299 students. Nurse observation form and nail follow-up chart were used to evaluate behavioral outcomes. This program was conducted under the guidance of school nurses and lasted 6 weeks. The data were analyzed using McNemar and Cochran Q tests. RESULTS The number of those who selected "yes" for "I cut my nails this weekend" and "I didn't bite my nails today" increased. However, the number of the students that selected "yes" for "I pulled out my nails," "I pulled out and ate," "I pulled out my nail skin," "My cuticle bled today," and "My nails hurt today" decreased significantly and statistically compared with pretest, first and second observation, and post-test (P < 0.001). The rate of the students with minimum one abnormal finger was 83.9% according to observations, and 6% following the intervention (P < 0.001). New insights were provided into the program to diminish nail-biting habit. PRACTICE IMPLICATIONS The program significantly reduced the nail-biting rate among primary school students. The nurse that implement this program will be able to do a comprehensive evaluation of students' nail-biting habits, perform solution-focused interventions, and prevent advanced complications that might develop in connection to nail-biting. Thus, the effectiveness of nursing implementations will improve in the prevention of nail-biting habit, early diagnosis, and changing students' habits. "Do Not Bite Your Nails, Cut Your Nails" program can be applied again in different schools.
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Affiliation(s)
- Kamer Gür
- Assistant Professor, Public Health Nursing Section, Faculty of Health Sciences, Department of Nursing, Marmara University, Maltepe, Istanbul, Turkey
| | - Saime Erol
- Associate Professor, Public Health Nursing Section, Faculty of Health Sciences, Department of Nursing, Marmara University, Maltepe, Istanbul, Turkey
| | - Nursultan İncir
- Nurse, Istanbul University Topkapı Mahallesi, Turgut Özal caddesi No: 118, 34093, Fatih, Istanbul, Turkey
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Sidiropoulou P, Sgouros D, Theodoropoulos K, Katoulis A, Rigopoulos D. Onychotillomania: A Chameleon-Like Disorder: Case Report and Review of Literature. Skin Appendage Disord 2018; 5:104-107. [PMID: 30815444 DOI: 10.1159/000489941] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 05/08/2018] [Indexed: 11/19/2022] Open
Abstract
Onychotillomania, or nail-picking disorder, is an uncommon and misdiagnosed behavioral pattern focused on the nail apparatus. It is demarcated by the compulsive or irresistible urge in patients to constantly injure their own nails, with the fingers or tools, inflicting noticeable or even irreversible self-destruction of the nail unit. Despite its rarity, this self-injurious coercion often poses a diagnostic and therapeutic challenge. Not only do many patients deny nail manipulation, but also the disorder has long been recognized to present itself with a wide range of clinical features, which hampers early and indisputable diagnosis. Furthermore, onychotillomania constitutes a persistent and hardly manageable problem, mostly because of its psychocutaneous nature as well as its high propensity to coexist with underlying neuropsychiatric illnesses or other behavioral disorders. However, the medical literature concerning obsessive nail picking still remains relatively scarce. Herein, we present an extraordinary, yet very intriguing case of a Caucasian patient with onychotillomania and onychophagia coexistence masquerading a weird inflammation-like lesion.
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Affiliation(s)
- Polytimi Sidiropoulou
- 1st Department of Dermatology-Venereology, National Kapodistrian University of Athens, Medical School, "A. Sygros" Hospital, Athens, Greece
| | - Dimitrios Sgouros
- 1st Department of Dermatology-Venereology, National Kapodistrian University of Athens, Medical School, "A. Sygros" Hospital, Athens, Greece
| | - Konstantinos Theodoropoulos
- 2nd Department of Dermatology-Venereology, National Kapodistrian University of Athens, Medical School, ATTIKON University Hospital, Athens, Greece
| | - Alexander Katoulis
- 2nd Department of Dermatology-Venereology, National Kapodistrian University of Athens, Medical School, ATTIKON University Hospital, Athens, Greece
| | - Dimitrios Rigopoulos
- 1st Department of Dermatology-Venereology, National Kapodistrian University of Athens, Medical School, "A. Sygros" Hospital, Athens, Greece
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Lee H, Lee W. Nail-extracting behaviour as an unusual manifestation of adjustment disorder, confused with onychotillomania. J Eur Acad Dermatol Venereol 2018; 32:e216-e217. [DOI: 10.1111/jdv.14733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- H. Lee
- Department of Dermatology; Yonsei University Wonju College of Medicine; 20 Ilsan-ro Wonju 26426 Korea
| | - W.S. Lee
- Department of Dermatology; Yonsei University Wonju College of Medicine; 20 Ilsan-ro Wonju 26426 Korea
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Borelli S, Lautenschlager S. [Nail diseases]. MMW Fortschr Med 2018; 160:52-57. [PMID: 29754380 DOI: 10.1007/s15006-018-0016-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Siegfried Borelli
- Dermatologisches Ambulatorium, Stadtspital Triemli Zürich, Herman-Greulich-Str. 70, CH-8004, Zürich, Schweiz.
| | - Stephan Lautenschlager
- Dermatologisches Ambulatorium, Stadtspital Triemli Zürich, Herman-Greulich-Str. 70, CH-8004, Zürich, Schweiz
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Treating onychotillomania can be challenging as no evidence-based treatment options are available. DRUGS & THERAPY PERSPECTIVES 2018. [DOI: 10.1007/s40267-018-0500-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Lipner SR. Habit Tic Nail Deformity. J Cutan Med Surg 2018; 22:222. [DOI: 10.1177/1203475417733468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Horne MI, Utzig JB, Rieder EA, Vincenzi C, Tosti A. Alopecia Areata and Habit Tic Deformities. Skin Appendage Disord 2018; 4:323-325. [PMID: 30410907 DOI: 10.1159/000486540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 12/28/2017] [Indexed: 11/19/2022] Open
Abstract
Nail involvement is a very common finding in patients with alopecia areata (AA). Most commonly evidenced by nail pitting, nail abnormalities can affect up to 66% of AA patients. We present two cases of the unusual association between habit tic nail deformities and AA.
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Affiliation(s)
| | - Joyce B Utzig
- Federal University of Southern Border, Passo Fundo, Brazil
| | - Evan A Rieder
- The Ronald O. Perelman Department of Dermatology, New York School of Medicine, New York, New York, USA
| | - Colombina Vincenzi
- Department of Specialised Experimental and Diagnostic Medicine, Dermatology, Alma Mater Studiorum - Università di Bologna, Bologna, Italy
| | - Antonella Tosti
- Departament of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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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.
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Lipner SR, Scher RK. Biotin for the treatment of nail disease: what is the evidence? J DERMATOL TREAT 2017; 29:411-414. [DOI: 10.1080/09546634.2017.1395799] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Affiliation(s)
- Adam Bayes
- 1 School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia
| | - Gordon Parker
- 1 School of Psychiatry, UNSW Sydney, Sydney, NSW, Australia.,2 Black Dog Institute, Randwick, NSW, Australia
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Lipner SR, Scher RK. Comment on “Psychocutaneous disease: Clinical perspectives”. J Am Acad Dermatol 2017; 77:e141-e142. [DOI: 10.1016/j.jaad.2017.05.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 05/22/2017] [Indexed: 11/28/2022]
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