Habit tic deformity with toenail involvement in an adolescent girl

A 17-year-old female presented with roughened, discolored toenails and thumbnails since childhood, with habitual nail picking. No family history. Examination showed multiple deep transverse grooves, brown–black chromonychia, loss of eponychium, and lichenified proximal nail folds [Figure 1a]. Thumbnails showed similar findings with remnants of pink nail lacquer [Figure 1b]. Onychoscopy of the right toenail (DermLite DL4N, ×10, polarized) revealed absent eponychium, periungual scaling, pigmentation, microhemorrhages, and deep transverse grooves on the nail plate overlying longitudinal brown chromonychia [Figure 2]. The pattern and lack of a midline canal favor habit tic deformity over Heller’s median canaliform dystrophy. No family history. This entity is a DSM-5 body-focused repetitive behavior; the patient was counseled on habit-reversal training.

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Figure 1:

(a) A 17-year-old female with habit tic deformity: Multiple deep transverse grooves (“washboard” nails), loss of eponychium, and periungual lichenification of toenails. (b) Bilateral thumbnails with transverse grooves, surface irregularity, brownish discoloration, and remnants of cosmetic nail lacquer.

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Figure 2:

Dermoscopy (Dermlite DL4N; ×10, polarized mode) of the right great toenail reveals an absent eponychium, periungual scale, punctate microhemorrhages (black circle), and longitudinal brown chromonychia overlying deep transverse grooves, supporting a trauma-induced nail change.

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