By Gary M. White, MD
Chronic picking of the proximal nail fold of the thumb by the index finger can cause a dystrophy of the nail. Multiple transverse lines resembling a wash board are seen.
Multiple transverse ridges of the thumbnail are characteristic. The lunula is usually large. The proximal nail fold skin is often thickened, scaly or otherwise abnormal reflecting manipulation of the skin (picking).
The patient merely needs to stop picking at the proximal nail fold. Unfortunately, this is easier said than done. I usually like to take a small circular "dot" bandage and place it over the proximal nail fold in the office. I then ask the patient to wear it for 3 days (change daily) to bring any rubbing or picking to a conscious level--thus allowing him/her to stop. Alternatively, cyanoacrylate adhesive (Krazy Glue) may be placed at the proximal nail fold to provide a sustainable barrier to trauma and to artificially recreate the absent cuticle. Patients are to apply the product 1 to 2 times weekly to maintain buildup at the cuticular sulcus. This can work very well.