CASE

A 67-year-old man presented to his primary care physician for routine care. The absence of cuticles was noted on his bilateral thumbnails, and a midline crease with horizontal ridges from the proximal nail fold to the distal nail (Fig. 1). The patient stated that these changes had been present for over a year. He admitted to frequent “picking” and biting of the cuticles and repeated hand washing, as evidenced by the xerosis of his fingers.

Figure 1
figure 1

Nail changes of onychotillomania. Note the midline furrow on the nail plate, with a series of transverse ridges.

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Habit-tic deformity is a type of onychodystrophy that is classified in a group of disorders known as onychotillomania, which includes entities such as nail biting (onychophagia), nail picking, and finger sucking.1 The deformity is the result of repetitive nail bed trauma from the conscious or unconscious manipulation of the cuticle. The characteristic findings include a midline furrow in the nail plate, often yellow in color, running the length of the nail, with a series of transverse ridges.2 Treatment includes physically covering the nails with bandages or glue to prevent further trauma. In addition, behavioral therapy and SSRIs have been tried, given the obsessive-compulsive nature of the habit.3 , 4 Cessation of the habit leads to complete resolution of the nail changes.