Abstract
Onychophagia (nail biting) and onychotillomania (nail picking) are chronic nail conditions categorized as body-focused repetitive behavior (BFRB) disorders. Due to a limited awareness of their clinical presentations, embarrassment on the part of patients, and/or comorbid psychiatric conditions, these conditions are frequently underrecognized and misdiagnosed. This article reviews the prevalence, etiology, diagnostic criteria, historical and physical exam findings, and treatment options for these conditions. The PubMed/MEDLINE database was searched for relevant articles. Onychophagia and onychotillomania are complex disorders necessitating a detailed patient history and physical examination and a multidisciplinary treatment approach for successful diagnosis and management. Due to the dearth of clinical trials for treatment of nail biting and nail picking, large clinical trials are necessary to establish standardized therapies.
Highlights
Onychophagia, or habitual nail biting, and onychotillomania, or repetitive nail picking and pulling, are chronic nail conditions categorized as body-focused repetitive behavior (BFRB) disorders
Nail biting and nail picking are relatively common in the general population, in children and individuals under stress, limited awareness of their clinical presentations, feelings of shame toward the habit, failure to refer to mental health specialists, and coexisting psychiatric conditions can contribute to delayed diagnosis and treatment
Onychophagia and onychotillomania are BFRBs that are often underrecognized in the clinical setting
Summary
Onychophagia, or habitual nail biting, and onychotillomania, or repetitive nail picking and pulling, are chronic nail conditions categorized as body-focused repetitive behavior (BFRB) disorders Both disorders can cause damage to the nail matrix, nail bed, nail plate, and periungual skin, creating physical and psychosocial consequences. While there is a growing interest in BFRB disorders, onychophagia and onychotillomania still receive less attention in the psychiatric and dermatologic literature compared to other self-inflicted dermatoses, like skin picking and hair pulling. This has created gaps in knowledge for recognizing these nail conditions, including delayed diagnosis, and nonevidence-based treatments. This review describes the clinical characteristics, psychiatric co-morbidities, and current treatments for onychophagia and onychotillomania
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