, Corinna Eleni Psomadakis2 and Bobby Buka3
(1)
Department of Family Medicine, Mount Sinai School of Medicine Attending Mount Sinai Doctors/Beth Israel Medical Group-Williamsburg, Brooklyn, NY, USA
(2)
School of Medicine Imperial College London, London, UK
(3)
Department of Dermatology, Mount Sinai School of Medicine, New York, NY, USA
Keywords
Median nailHabitTicDeformityOnychotillomaniaThumb nailTraumaNail pickingPsychologyPsychologicalFluoxetineProzac
Fig. 19.1
Central canaliculi bilateral thumbs is pathopneumonic for this condition
Fig. 19.2
Prominent clubbing results from local nail bed inflammation after repeated trauma
Primary Care Visit Report
A 27-year-old female with past medical history of asthma , hypothyroidism, and depression presented with bilateral distortion of her thumbnails that started 2–3 years prior. She said that the base of her thumbnails started to “bubble,” which then seemed to resolve on it’s own until about 2 months prior. The thumbnail symptoms then began to recur, and were more severe again at the time of this visit, with parts of the thumbnails “tearing off.”
Vitals were normal. On exam, the bases of her bilateral thumbnails featured deep grooves, some erosion, and dipping and spooning.
Fungal infection was considered, but the nails did not appear typical of onychomycosis. The patient was referred to dermatology , and photos were sent to a dermatologist who said it looked like there had been trauma to the nails. The patient had not mentioned anything about trauma when she presented, but when later asked whether she picked at her nails or cuticles, she described herself as a “voracious nail picker.”
Discussion from Dermatology Clinic
