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Nail biting is a nervous habit that usually begins in childhood and may persist into adulthood. Up to 33% of children aged 7 to 10 years and 45% of adolescents are nail biters. Most of these cases are benign. Possible causes include stress, heredity, and imitation of the behavior of family members. Some cases may evolve from prolonged thumb sucking. The nail plate may be bitten from the nail bed. Strips of skin on the lateral and proximal nail folds may also be bitten.
Differential diagnostic considerations include severe lichen planus of the nails (i.e., inflammation of the matrix, nail bed and nail folds) with pterygium formation (overgrowth of cuticle), onycholysis (painless separation of nail from nail bed), extensive nail psoriasis, and trauma. Most of the time differential diagnosis is unnecessary as patients either admit to nail biting, or parents observe it. Complications of nail biting include damage to the cuticles and nails, bacterial infections, paronychia (infection adjacent to nail) and dental problems. Phalangeal osteomyelitis (finger bone infection) is a rare complication. Nail biting is exacerbated by physical inactivity. Periods of physical activity may allow for normal nail growth. Affected patients are usually aware of their habit but unable to control it. In children, nail biting may be associated with trichotillomania (irresistible urge to pull one’s hair). The DSM-IV includes nail biting as one of the impulse control disorders. Many of these patients have anxiety disorders. Several treatment methods are available, depending on the severity of the condition. In young children, ignoring the condition and allowing time to pass may be an adequate approach until the habit disappears. In other children, behavior modifications may be necessary. These include: motivation (praise any progress), response-prevention (reward the child for not biting), hypnosis and relaxation, awareness raising (point out others’ good-looking nails), avoidance training (have child bite nails in front of mirror to trigger revulsion), and substitution (have child squeeze a small object when feeling urge to bite). These interventions have produced a 22% increase in subject’s nail length, compared with only 3% in patients treated with placebo. Painting nail plates with distasteful materials such as Nail Cure or Sally Hansen Nail Biter may create aversion to nail biting. In one study, mild aversion resulted in significant improvements in nail length. (Jabr FI. Postgraduate Medicine 2005; 118(3):37-42.) -- H.T. |
