Onychotillomania
Onychotillomania is an uncontrollable desire to pick or tear the nails, usually a manifestation of a compulsion neurosis. It is similar to, but to be differentiated from, onychophagia, the habit of biting the free edge of the nails. Either may result in pronounced nail deformities. The treatment of onychotillomania consists in psychotherapy and the application of occlusive dressings. A fairly extensive review of the literature in English fails to disclose a single recorded case of this disease. In the German literature, Alkiewicz1 refers to the condition.
Frequent application of distasteful topical preparations on the nail and periungual skin can discourage patients from biting and chewing their finger nails. Possible alternatives include:
* 1% clindamycin.
* quaternary ammonium derivatives.
* 4% quinine sulphate in petrolatum.
Patients with severe onychophagia or median nail dystrophy can be helped by daily bandaging the injured fingers with permeable adhesive tape. Fluoxetine at high dosages (60 mg/day) can be helpful in interrupting this compulsive disorder in adults.off.