Instant glue for habit-tic deformity

By Dra. Florez

 

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:

Inexpensive solution for habit-tic deformity.

Ring DS.

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.

 
  • 10 Comments in “Instant glue for habit-tic deformity”
  1. Joe Monroe, PA-C says:  

    I believe that a possible contributory factor is atopic dermatitis (eczema), which causes dryness of the cuticles and nail plate, leading to picking by the patient. There are other models for this theory, such as chronic candidal paronychia which begins with obliteration of the cuticle, opening the space to invasion by microorganisms. This condition also involves dystrophy of the affected nail, often in a transverse orientation, though it is not at all clear that this is secondary to anything the patient does.
    In any case, it might make sense to direct attention to “the” issue, that is, the cuticle itself, by way of careful nail care (atraumatically trimming the cuticle, pushing it back, moisturizing the cuticle) as a substitute/remedy, in any case, avoiding separation of the cuticle from the nail plate.

  2. Theresa Sanders says:  

    is there ever pain involved with this condition

  3. Barbara Lopez says:  

    My teen autistic son had this condition, and the Dr. could not identify it. This makes sense, because he has a problem with other tics, which seem to last about six weeks or more, but eventually are replaced with something else. His thumb nails are normal now, but now his tic is hitting himself in the temple with his fist, resulting in a big welt on the side of his face. I was wondering if you have any insight about treating the underlying cause of the need to “tic”. Another relative in the family had success as a child with high dose B6 and magnesium, but this son does not tolerate that product. The B6 (Super Nu Thera) stopped his tics, which were facial grimmaces, for five or six years. Then in middle school he refused to take it, would pretend to take them and hide the pills around the house. But by then he seemed to have outgrown the problem, he has no tics now as an adult. The autistic one is improving in maturity and cognitive skills, but these tics are ruining his social life, really making him look more odd and disabled than he really is. If you insist on stopping it with behavior mod, he just replaces it with something else. I am afraid he is going to damage his eyesight, which is already impaired.

  4. Dra. Florez says:  

    Yes, the condition can present with pain.
    Yours sincerely,
    Dr. A. Flórez.

  5. Dra. Florez says:  

    Unfourtunately, I cannot help you with your son since I am a dermatologist. In my opinion you should visit a doctor specialist on the subject.
    Yours sincerely,
    Dr. A. Flórez.

  6. B. Smith says:  

    Where can one find “Ring” for the cuticle base/bed of the nail? I have had this habit for well over 10 years and have found it virtually impossible to stop. I’d be interested in trying the treatment described (above).

  7. Dra. Florez says:  

    According to Dr. Ring you just have to place instant glue (cyanoacrylate adhesive) at the proximal nail fold, 1 to 2 times weekly, until a normalization of nails is achieved.
    Yours sincerely,
    Dr. Flórez.

  8. AC Hollinger says:  

    I had horribly ridged thumb nails for 30 years due to a picking habit. Five months ago I started the Super Glue treatment and it has worked. My nail is growing out normally and looks beautiful. Whenever I would try to pick, my fingers would encounter the hard crust of glue in the cuticle, and I would be reminded to stop. I only needed to use the glue for a week or two. The Super Glue stays on there for a long time. I also had pain and inflammation of the flesh around the nail. This went away completely within a few days. After two months I was able to detect smooth, normal nail growth, which went a long way toward motivating me not to pick. The cuticle looks perfect, and in a couple of months I expect no traces to remain of the deformation.

  9. M McAtee says:  

    I am 27 years old and have had ridges on my thumbnails as long as I can remember. I am desperate to stop digging and to have normal nails for once! What type of super glue should I use? Any store bought Krazy Glue? Or should I buy a specific kind? Please help!

  10. Dra. Florez says:  

    What Dr. Ring proposed is to use a type of instant glue made up of cyanoacrylate adhesive.
    Sincerely,
    Dr. A. Flórez

 

Leave a Reply

If you would like to add an image or a PDF file to detail your comment, you can upload it here.
JPG file (less than 500 pixels wide) or PDF file