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

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.

Update on Diagnosis and Management of Onychophagia and Onychotillomania

“…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 ].…”

Pszichodermatológia és egészségpszichológiai ellátás a bőrgyógyászatban

“…Találhatunk ilyen leírásokat többek között a közönséges akne (Stamu-O'Brien et al, 2021), a pikkelysömör (Torales et al, 2020) és a hajbetegségek Montgomery et al, 2017) témáiból. Ritka bőrbetegségek pszichés oldalával foglalkozó cikkek is hasznosak lehetnek a bőrgyógyászati ellátások számára, mint például: az onychotillomania-nak, melynél a páciens repetitív viselkedésével károsítja saját köröm apparátusát (Sidiropoulou et al, 2019), vagy a dermatitis neglecta-nak, mely az alacsony higiéniai szint következtében kialakult betegség (Lopes et al, 2018), vagy a Gardner-Diamond szindrómának, melynél rózsaszín vagy vörös ödémás plakkok jelennek meg a páciensen súlyos stressz megtapasztalását és érzelmi traumát követően, és a betegség bőrgyógyászati, pszichoterápiás és pszichiátriai ellátást is igényelhet (Jafferany & Bhattacharya, 2015).…”

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

“…To further complicate matters, both periungual and digit cutaneous tissues may be involved. This protean phenotype renders onychotillomania a dermatological masquerader able to mimic various nail disease entities [2,3].…”

“…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. This urge may be conscious or unconscious [1,2]. Clinically, onychotillomania is characterized by a range of nonspecific findings, including bizarre morphology of the nail plate and damage to the nail bed and periungual skin.…”

“…Onychotillomania often poses a therapeutic challenge. It constitutes a persistent and difficult-to-manage problem, mostly because of its psychocutaneous nature as well as its high propensity to coexist with underlying neuropsychiatric illnesses or other behavioral disorders [2]. 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.…”