Worn-Down Nails: A Rare Entity

Abstract

This case report discusses a rare condition known as bidet nail syndrome, characterised by worn-down triangular nails resulting from repetitive rubbing against bidet porcelain during genital area cleaning. The patient, a 35-year-old male pharmacist, presented with splitting and redness in the nail plates of both big toes, attributed to tight and anteriorly covered shoes. Clinical examination revealed a triangular area of nail thinning with slight redness and a thin brown line along the edges. Dermoscopic findings indicated nail bed reddening, enlarged capillaries and small areas of bleeding corresponding to nail thinning. The provisional diagnosis included worn-down nails, lacquer nails and onychoteiromania, with the final confirmation of worn-down nails. The patient showed significant improvement after changing footwear, emphasising the importance of lifestyle modifications. The bidet nail syndrome, initially described in 1999, is associated with chronic scratching or manual labour, with susceptibility to nail plate damage varying among individuals. This case underscores the need for dermatologists to recognise and differentiate worn-down nails from similar conditions, enabling accurate diagnosis and avoiding unnecessary treatments. Overall, bidet nail syndrome is a self-limiting condition, emphasising the importance of a thorough medical history for effective management.