Self-induced nail disorders

Nail is a hard cutaneous structure; however, it is susceptible to external and self-induced injury that can lead to alterations in morphology. Self-induced nail disorders are a group of varied clinical manifestations that are caused by the patient voluntarily. They are classified as body-focused repetitive behaviour disorders (BFRBs). Common habits that lead to nail changes but are not associated with overt psychological abnormalities include onycholysis semilunaris, habit tic and onychophagia. The other major class includes nail disorders associated with psychiatric diseases, for example, onychodaknomania. These disorders often mimic a variety of nail conditions. Patients may not present to clinicians with these disorders as the primary complaint. An underlying psychiatric or psychological condition is often found, especially in adults. Hence, clinicians need to be aware of this clinical entity to be able to offer correct diagnosis and appropriate management. Multidisciplinary management is suggested, involving both non-pharmacological and pharmacological approaches. Behavioural interventions such as habit reversal therapy have a role in management. This article is aimed at analysing and presenting literature about these nail disorders to raise awareness. It discusses in detail various clinical entities, pathomechanisms, associated disorders and management.