Adult onychotillomania, or habit-tic deformity, is a relatively frequent dermatological disorder. It generally involves one or both thumbnails, and it is due to the continuous habit of manipulating the proximal fold cuticle. Although not a worrying medical problem, habit-tic deformity can be challenging for the every-day practitioner since treatment options are limited and not always very efficacious. In the last November issue of the Archives of Dermatology, Doctor Daniel S. Ring addresses this subject:
Archives of Dermatology. 2010 Nov;146(11):1222-3. PMID: 21079056
The author communicates the clinical cases of two adult men which had been suffering from habit-tic deformity of the thumbnails for many years. The patients recognized to be frequently embarrassed due to the appearance of their nails. Previous medical histories, drug intake or family medical histories were not relevant. The patients denied previous dermatitis involving the skin of the proximal nail folds. Patients presented with the classical manifestation of the disease: parallel transverse ridges deforming both thumbnails from the proximal nail fold to the distal part of the nail plate, lack of cuticle and widening of the cuticular sulcus. No previous treatment had been prescribed.
Although very common, this topic is not frequently addressed in dermatology therapeutic forums. Generally accepted standard treatment is to bandage the nails in order to create a barrier that isolates them from external aggressions. This method has low compliance due to cosmetic reasons in an adult patient. Behavioural and pharmacological psychiatric interventions, based on the relationships between onychotillomania and obsessive-compulsive disorder, have also been communicated.
What Ring proposed is to place a type of instant glue (cyanoacrylate adhesive) at the proximal nail fold. Patients were instructed to apply it 1 to 2 times weekly to artificially imitate the cuticle function and avoid new trauma. After several months of use, on average the product was only used once a week, patients achieved a normalization of both thumbnails.
The role in modifying habitual behaviour, so that relapses are avoided after the therapy is stopped, is an interesting point. Once patient number 1 had recovered normal nails he discontinued therapy observing a relapse. Therapy was then reintroduced following the same regimen and a new resolution of thumbnail dystrophy was documented after several months. A new interruption of treatment was followed by preservation of normal nails due to cessation of his picking habit.
The author underlines the need to inform the patient about the possibility of developing allergic contact dermatitis to acrylates, in order to early stop the treatment.
Of course this study is limited by the small number of patients included, the absence of control and of long-term follow-up, but the therapy is promising since it is inexpensive, easy to be used by the patient and acceptable from a cosmetic point of view.