Art of Prevention: The importance of tackling the nail biting habit

Abstract

Onychophagia, commonly referred to as nailbiting is a chronic condition that is repetitive and compulsive in nature, and generally seen in both children and young adults. Multiple factors play a role in the development of nailbiting, ranging from genetic components, to underlying psychiatric conditions. Complications of chronic, compulsive nail-biting range from obvious distortion of the nail bed unit, to ungual and oral infection. Dental hygiene is, typically, less well-maintained in patients with nail-biting disorders: teeth may become chipped or notched, and gums many become inflamed. Treatment of nailbiting involves a multidisciplinary team that provides social, psychiatric, dermatologic, and dental care. Treatment ranges from psychotherapy modalities, to medication trials of selective serotonin reuptake inhibitors and N-acetylcysteine. Proper nail hygiene remains a mainstay in the prevention of the complications of chronic nail-biting. Additional supportive measures include the support of self-motivational novels and television episodes that help children learn coping mechanisms.

Review of the diagnosis and management of pediatric psychodermatologic conditions: Part I

“…The onset of nail‐biting behavior is most common during childhood and adolescence with the fingernails, rather than the toenails, being the most commonly involved area 23 . Psychosocial stressors exacerbate nail biting with patients reporting feelings of anxiety, stress, boredom, and hunger preceding the nail‐biting behaviors 23‐25 . In addition, patients with onychophagia report significant impairments in quality of life and stigmatization compared with controls 26 .…”

“…Assessment of severity is the first step in determining an appropriate management regimen. Children with mild disease may not need any intervention because they typically outgrow this behavior 25 . It is important to discuss with the parents that negative repercussions or punishment for nail‐biting activities are ineffective management methods and may even encourage the patient to continue the activity, as it garners attention 28 …”

“…The application of bandages over the nails, or regularly scheduled manicures, has been suggested to discourage nail‐biting behavior, noting repetitive professional manicuring can be cost prohibitive 28 . Ultimately, the parent's approval and engagement in the treatment regimen are vital to increasing patient adherence, as they are responsible for reinforcing the behavioral modifications or pharmacological treatment 25 …”

“…For more significant disease, multidisciplinary care with dentistry is critical given the oral sequelae secondary to chronic nail biting 25 . Those with moderate‐to‐severe disease may be treated with self‐monitoring and HRT 1 .…”

Update on Diagnosis and Management of Onychophagia and Onychotillomania

“…For nail biters, the application of an unpleasant-tasting polish to the nails interferes with the enjoyable aspect of biting. Aversion therapy is discouraged in younger children as it may induce opposition, leading to increased nail biting to attract attention [ 32 , 33 ]. The success of aversion therapy is dependent on consistent reapplication of the polish.…”