By Gary M. White, MD
Onychophagia, or nail biting, is a habit most common in children that results in shortened, split, and irregular nails. The term onychotillomania is used when tools such as pliers or scissors are used to destroy the nail plate. This disease, in contrast to onychophagia, may signify an underlying psychiatric disturbance.
- Common nervous habit in children causing disruption of the skin about the nail.
- May occur when the patient is concentrating or anxious.
The patient should be encouraged not to bite. A distasteful topical substance may be applied to the nail (e.g., Sally Hansen Nail Biter). A tricyclic antidepressant such as clomipramine is also an effective treatment. A small double-blind comparison study showed clomipramine to be superior to desipramine [Arch Gen Psychiatry 1991:48;821-7]. Pimozide has been used for onychotillomania.
One patient, who successfully learned to control his condition, recommended the following three essentials as key to recovery:
- The will to stop.
- Keep a nail file handy. Some people say this is the most important one, because they only bite their nails because of rough edges. If that's true for you, it'll help a lot, but I bit my nails out of boredom and/or stress.
- Apply a nail hardener. Make your nails all smooth (it helps obviously to not have bitten them for 1-2 days) with a file. Apply nail hardener. It basically looks like see-through nail-polish and will make your nails shine a little bit. The nail hardener does 2 things: First, it makes biting your nails more difficult, because they are actually thicker now and not as soft as before. Second, it makes biting your nails not attractive anymore, because of that nail-polish-looking stuff on your nails. It has the nice side-effect that it will, over time, actually harden your nails.
Chronic nail biting. On the right, a pyogenic granuloma has formed due to the repeated trauma.
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