Self Induced Nail Disorders

Abstract

Onychophagia and onychotillomania are self-induced nail disorders. Onychophagia involves compulsive biting of the nail past the nail bed leading to nail deformity, textural changes, bleeding cuticles, and risk for infection. Onychotillomania involves tugging, picking, pulling, and manicuring of the nail causing damage and deformity of the nail and surrounding tissue. Diagnostic criteria and management strategies are discussed.

In humans, concerns regarding nail appearance and integrity are common throughout life. Perceptions about an individual’s health, beauty, style, attitude, and sexuality can all be influenced by the appearance and adornments of the nails. Dystrophic nails elicit a range of negative appraisals and anxieties from others. They can indicate circumstances such as poor hygiene, poor diet, illness, infection, or psychiatric illness. It seems counterintuitive that one would purposely damage or substantially deform their nails, but most self-induced damage to the nails is not carried out with the intention to create changes that can alienate, frighten, or even repulse others. These behaviors are usually secondary to anxiety, depression, boredom, frustration, or genetic disorder. These patients represent a heterogeneous population often with numerous personal and family comorbidities. Thus far, few placebo controlled double blinded interventions have been carried out in relation to the treatment of self-induced nail disorders. In this chapter, we will review the most common self-induced nail disorders and their most effective treatments.