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International Journal of Environmental... May 2022Trichotillomania (TTM), excoriation disorder, onychophagia, and onychotillomania are categorized as body focused repetitive behavior (BFRB) disorders, causing damage to... (Review)
Review
BACKGROUND
Trichotillomania (TTM), excoriation disorder, onychophagia, and onychotillomania are categorized as body focused repetitive behavior (BFRB) disorders, causing damage to the skin, hair, and/or nails with clinically significant psychosocial consequences. Currently, there are no standardized treatments for these compulsive, self-induced disorders. Studies on treatment of these disorders using psychotropic drugs (i.e., selective serotonin reuptake inhibitors, tricyclic antidepressants, anticonvulsants) have shown variable efficacy. Recently, there is a growing interest in -acetylcysteine (NAC) for treating BFRBs. NAC is a glutamate modulator that has shown promise in successfully reducing the compulsive behaviors in BFRB disorders. This article provides an updated review of the literature on the use of NAC in TTM, excoriation disorder, onychophagia, and onychotillomania.
METHODS
Relevant articles were searched in the PubMed/MEDLINE database.
RESULTS
Twenty-four clinical trials, retrospective cohort studies, and case reports assessing the efficacy of NAC in TTM, excoriation disorder, and onychophagia were included. No studies for onychotillomania were found in our search.
CONCLUSIONS
Although NAC has proven successful for treatment of BFRB disorders, data is derived from few clinical trials and case reports assessing small numbers of patients. Larger studies with longer durations are needed to fully establish the efficacy of NAC in these disorders.
Topics: Acetylcysteine; Compulsive Behavior; Humans; Nail Biting; Retrospective Studies; Trichotillomania
PubMed: 35681955
DOI: 10.3390/ijerph19116370 -
International Journal of Environmental... Mar 2022Onychophagia (nail biting) and onychotillomania (nail picking) are chronic nail conditions categorized as body-focused repetitive behavior (BFRB) disorders. Due to a... (Review)
Review
Onychophagia (nail biting) and onychotillomania (nail picking) are chronic nail conditions categorized as body-focused repetitive behavior (BFRB) disorders. Due to a limited awareness of their clinical presentations, embarrassment on the part of patients, and/or comorbid psychiatric conditions, these conditions are frequently underrecognized and misdiagnosed. This article reviews the prevalence, etiology, diagnostic criteria, historical and physical exam findings, and treatment options for these conditions. The PubMed/MEDLINE database was searched for relevant articles. Onychophagia and onychotillomania are complex disorders necessitating a detailed patient history and physical examination and a multidisciplinary treatment approach for successful diagnosis and management. Due to the dearth of clinical trials for treatment of nail biting and nail picking, large clinical trials are necessary to establish standardized therapies.
Topics: Compulsive Behavior; Humans; Nail Biting; Nails; Physical Examination; Prevalence
PubMed: 35329078
DOI: 10.3390/ijerph19063392 -
International Journal of Women's... Jun 2021Onychophagia, commonly referred to as nail biting, is a chronic condition that is repetitive and compulsive in nature, and generally seen in children and young adults.... (Review)
Review
Onychophagia, commonly referred to as nail biting, is a chronic condition that is repetitive and compulsive in nature, and generally seen in children and young adults. Multiple factors play a role in the development of nail biting, ranging from genetic components to underlying psychiatric conditions. Complications of chronic, compulsive nail biting range from obvious distortion of the nail bed unit to ungual and oral infection. Dental hygiene is typically less well-maintained in patients with nail-biting disorders, and teeth may become chipped or notched and gums many become inflamed. Treatment of nail biting involves a multidisciplinary team that provides social, psychiatric, dermatologic, and dental care. Treatment ranges from psychotherapy modalities to medication trials of selective serotonin reuptake inhibitors and N-acetylcysteine. Proper nail hygiene remains a mainstay in the prevention of the complications of chronic nail biting. Additional supportive measures include the support of self-motivational novels and television episodes that help children learn coping mechanisms.
PubMed: 32964094
DOI: 10.1016/j.ijwd.2020.09.008 -
Journal of Clinical and Experimental... Dec 2019Chronic nail biting is common in children and young adults. Auto inoculation of environmental pathogens can manifest as infection in distant organs. Multi-drug...
BACKGROUND
Chronic nail biting is common in children and young adults. Auto inoculation of environmental pathogens can manifest as infection in distant organs. Multi-drug resistance gram negative bacteria are on the rise globally. Several of the foodborne bacteria fall within the Enterobacteriaceae family but very few studies have explored these microbes in the oral cavity of children with chronic nail-biting habit or orthodontic treatment. The study aims to investigate oral load of Enterobacteriaceae in children with chronic nail-biting habit and or those undergoing orthodontic treatment.
MATERIAL AND METHODS
150 children (no nail-biting n=30, nail biting n=60, fixed orthodontic treatment n =30 and a combination of fixed orthodontic appliance use and nail-biting habit n =30) were assessed for culture based microbiological investigation. The concentrated oral rinse technique was used. The rinse was inoculated in MacConkey's and Blood Agar. The gram stained culture was subjected to biochemical tests for sub-species identification using Biomerieux Vitek 2 Compact Automated Microbiological Analyzer. Fisher's exact and Kruskal Wallis with post hoc analysis using Dunn method was performed to test association and difference between groups.
RESULTS
Enterobacteriaceae was positive for 72% of the children. Of them, nail biting or orthodontic treatment group comprised 89%. Those with a combination of nail biting and undergoing orthodontic treatment exhibited highest CFU/ml and those without nail biting or orthodontic treatment exhibited the lowest. Three of the four organisms isolated tested positive in the orthodontic treatment group. was positive in 38% of the children while and were isolated exclusively in the orthodontic treatment group.
CONCLUSIONS
Chronic nail biting or the use of fixed orthodontic appliances is associated with higher incidence of Enterobacteriaceae in the oral cavity. Oral health professionals play an important role in preventing multi drug resistance infectious diseases. Enterobacteriaceae, nail-biting, Onychophagia, orthodontic treatment.
PubMed: 31824597
DOI: 10.4317/jced.56059 -
Cureus Mar 2022Habit-tic nail deformity, onychophagia (also referred to as nail biting) and onychotillomania (also referred to as nail picking) are body-focused repetitive behaviors...
Habit-tic nail deformity, onychophagia (also referred to as nail biting) and onychotillomania (also referred to as nail picking) are body-focused repetitive behaviors that can involve the nails and periungual skin. Patients with habit-tic nail deformity are typically unaware that repeatedly using their nail, often the adjacent index finger, to rub the proximal nail fold and its underlying matrix - usually of one or both of their thumbnails - is the cause of the longitudinal depressed groove that extends along the entire the nail plate. Nail biters usually bite multiple nails - most commonly on the digits of the hands - and the patient is cognizant of their behavior. However, the term onychophagia is a misnomer and onychodaxia would be a more appropriate nomenclature. Nail pickers also often realize that their dystrophic nail results from using other nails or tools to pick, pull, or excessively manicure the affected nail. Individuals with habit-tic nail deformity or onychophagia or onychotillomania may concurrently have other repetitive behaviors involving the skin or the hair or both. Three patients with a nail-associated body-focused repetitive behavior are described who not only presented with dystrophy of their nails but also abnormalities of the adjacent nail apparatus: a 36-year-old woman with habit-tic nail deformity and dermatodaxia, a 64-year-old man with biting of both the nails and the skin, and a 63-year-old man with nail picking and skin picking. The nail dystrophy and concurrent skin biting or skin picking were not the issues that prompted the reported patients to seek evaluation by a physician; the body-focused repetitive behaviors of the nails and skin were incidental findings during their cutaneous examination. The management of nail-associated body-focused repetitive behavior may include non-pharmacologic treatments (such as physical modalities and behavior modifications) and/or pharmacologic agents. The reported woman with habit-tic nail deformity was willing to consider an attempt to modify her repetitive behavior by using paper tape as a physical modality to cover the area on her thumbs that she would unconsciously rub. However, similar to the men in this report with onychophagia and onychotillomania, many of the patients with nail-focused repetitive behaviors do not want to initiate any interventions that might decrease or eliminate their nail condition.
PubMed: 35382180
DOI: 10.7759/cureus.22818 -
Cureus Feb 2022Dermatodaxia describes humans who bite their skin. Previously used designations, which are less appropriate, have included chewing pads, wolf-biter, and dermatophagia....
Dermatodaxia describes humans who bite their skin. Previously used designations, which are less appropriate, have included chewing pads, wolf-biter, and dermatophagia. Dermatodaxia is a body-focused repetitive behavior and is classified in the category of obsessive-compulsive and related disorders. People who bite their skin may concurrently have other related disorders such as dermatillomania (also referred to as skin picking) affecting their cutaneous integument, trichotillomania (also referred to as hair-pulling) affecting their hair, and/or onychophagia (also referred to as nail-biting) affecting their nails. A man with multiple medical conditions presented for follow-up evaluation of a recently treated superficial skin infection of his abdomen. Cutaneous examination not only showed complete resolution of an abdominal abscess but also dermatodaxia involving his dorsal left index finger; the skin biting site appeared as an asymptomatic lichenified nodule with overlying scaly hyperkeratosis. Additional inquiry confirmed that for several decades he would repeatedly bite this finger. He was aware - and even demonstrated - that his skin biting caused the lesion. He also declined any interventions to alter his behavior. Similar to the patient in this report, dermatodaxia typically presents as an asymptomatic, unilateral, solitary, lichenified, callous-like, thick nodule; however, bilateral involvement or multiple biting sites or both may occur. Lesions typically occur on the forearm, hands, and fingers; on the latter site, they may or may not involve the knuckles. Physical modalities, behavior modifications, and/or pharmacologic agents may be used in the management of dermatodaxia; however, many individuals with dermatodaxia - similar to the reported man - are not only aware that the cutaneous lesion is caused by their skin biting but also do not want to entertain the possibility of initiating any intervention that might change or stop their skin biting.
PubMed: 35350511
DOI: 10.7759/cureus.22289 -
BMJ Open Sep 2022To evaluate the prevalence of nail biting in child and adolescent outpatients at a single institution and the chronological relationship between nail biting and tics in... (Observational Study)
Observational Study
Prevalence of nail biting and its chronological relationship with tics in child and adolescent outpatients with Tourette syndrome: a single-centre, retrospective observational study.
OBJECTIVE
To evaluate the prevalence of nail biting in child and adolescent outpatients at a single institution and the chronological relationship between nail biting and tics in patients with Tourette syndrome (TS) with or without attention-deficit hyperactivity disorder (ADHD).
DESIGN
Retrospective observational study.
SETTING
Teaching hospital in Taiwan.
PARTICIPANTS
All participants were aged 4-18 years, including 535 patients with TS, 230 patients with provisional tic disorder and 1460 patients without neurological or psychiatric disorders (controls).
OUTCOME MEASURES
Presence of nail biting, starting age for nail biting and starting age for motor and/or vocal tics.
RESULTS
Nail biting was more commonly observed in patients with TS (56.6%) than in patients with provisional tic disorder (27.4%) or controls (15.0%), regardless of sex (all p<0.020). Nail biting was also more common in patients with TS with ADHD than in those without (75.0% vs 47.6%; p<0.001), but the starting age was significantly later in those with concomitant ADHD than without (5.3 vs 3.8 years; p<0.001). In patients with TS, the onset of nail biting occurred earlier than that of tics, regardless of ADHD status.
CONCLUSION
Nail biting was more prevalent and occurred earlier than tics in patients with TS, regardless of ADHD status, in the study population.
Topics: Adolescent; Child; Humans; Nail Biting; Outpatients; Prevalence; Tic Disorders; Tics; Tourette Syndrome
PubMed: 36109039
DOI: 10.1136/bmjopen-2022-063874 -
Science Progress Oct 2021Although onychophagia is a medical condition and is associated with poorer health, there are no guidelines for assessment or treatment. The purpose of this study was to... (Review)
Review
Although onychophagia is a medical condition and is associated with poorer health, there are no guidelines for assessment or treatment. The purpose of this study was to investigate the clinical aspects of nail biting from doctors' points of view, to estimate the prevalence of onychophagia among physicians, and to review the literature on and treatment methods for onychophagia. Twenty-four percent of doctors reported nail-biting periods during their lifetimes, and 2% of them remained active nail biters. A total of 64.4% of doctors see nail biting in their practices, and 60.6% never or only on request ask patients about nail biting and examine their nails. Family doctors and pediatricians ask their patients about nail biting most often. Attitudes and opinions on the treatment of nail biting are undefined and vary. Doctors reported usually treating nail-biting patients by referring them to another specialist or offering special nail polish. There is a need to improve physicians' knowledge of nail-biting treatment methods, but a lack of studies evaluating the clinical aspects of onychophagia and its relation to mental health and emotion dysregulation. Further research is needed. Clinical attitudes toward nail biting could be more precise in training and medical practice.
Topics: Humans; Nail Biting; Nails; Physicians; Pilot Projects; Prevalence
PubMed: 34874802
DOI: 10.1177/00368504211050288 -
BMC Pediatrics Oct 2023Malocclusion is a multifactorial condition associated with genetic and environmental factors. The purpose of this study was to investigate the prevalence of occlusal...
BACKGROUND
Malocclusion is a multifactorial condition associated with genetic and environmental factors. The purpose of this study was to investigate the prevalence of occlusal traits, oral habits, and nose and throat conditions by age and to assess the association between malocclusion and its environmental factors in Japanese preschool children.
METHODS
A total of 503 Japanese children (258 boys and 245 girls aged 3-6 years) were recruited. Occlusal traits were assessed visually to record sagittal, vertical, and transverse malocclusion, and space discrepancies. Lip seal was recorded by an examiner, and oral habits (finger sucking, lip sucking or lip biting, nail biting, chin resting on a hand) and nose and throat conditions (tendency for nasal obstruction, allergic rhinitis, palatine tonsil hypertrophy) were assessed by a questionnaire completed by the parents. The prevalence of each item was calculated, and binary logistic regression was used to examine the factors related to malocclusion.
RESULTS
62.0% of preschool children in the present study exhibited malocclusion, and 27.8% exhibited incompetent lip seal. Nail biting was the most frequent oral habit with a prevalence of 18.9%. Nasal obstruction was recorded in 30.4% of children. The results of binary logistic regression showed that incompetent lip seal was significantly related to malocclusion, and that nail biting was significantly negatively related.
CONCLUSIONS
Incompetent lip seal is significantly associated with malocclusion, but nail biting may not necessarily be a deleterious habit for the occlusion in Japanese preschool children.
Topics: Child, Preschool; Female; Humans; Male; East Asian People; Fingersucking; Habits; Lip; Malocclusion; Nail Biting; Nasal Obstruction; Risk Factors; Child
PubMed: 37884943
DOI: 10.1186/s12887-023-04366-7