REPORT OF A CASE
A 45-year-old white man with no significant medical or psychiatric history complained of a 20-year history of eczema on his fingers. Previous treatment included application of 1% ciclopirox olamine lotion twice daily. This resulted in no significant improvement.
On physical examination, several of his fingernails showed loss of the cuticles, parallel transverse grooves with a central depression, and elongation of the lunulae. The proximal and lateral nail folds had edematous, erythematous plaques with linear, angulated erosions (Figure 1). These findings were consistent with habit-tic deformity and trauma in the periungual area from picking.
On further questioning, the patient admitted to a long history of the habit of manipulating the periungual area. In particular, the area of the proximal nail fold underwent repeated trauma in an almost unconscious habit.
The patient was referred for psychiatric evaluation to determine whether his dermatologic condition was caused by a psychiatric
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