Habit-Tic Deformity

Diagnosis: Habit-Tic Deformity

Median nail dystrophy, resulted from the common tic of the proximal nail fold with the index finger

Clinical Presentation

Median nail dystrophy, resulted from the common tic of the proximal nail fold with the index finger

Clinical History

Submitted by Alaa Saad. Originally posted September 4, 2010.

Treatment

See case discussion.

Differential Diagnosis

• Median nail dystrophy • Lichen planus (nail) • Psoriatic nail dystrophy • Onychomycosis • Darier disease (nail)

Key Learnings

• Central longitudinal ridge with horizontal grooves on thumbnail — "washboard" or "fir tree" pattern • Caused by habitual picking/pushing of proximal nail fold/cuticle • Most common on thumbnails — bilateral involvement common • Diagnosis is clinical — patient often unaware of the habit • Enlarged lunula (from chronic cuticle manipulation) is a clue • Completely reversible if the habit stops

Tags: habit, tic, deformity, alaa saad