Nail biting, also known as Onychophagia

Nail biting, also known as Onychophagia

September 07, 2020

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Nail biting, medically referred to as onychophagia, is a habit that can start early in life and be tough to break!  Most have tried some method of stopping- dipping their nails in salt, hot peppers, or some other foul tasting product; Snapping a rubber band on the wrist, getting a manicure, etc. etc.  There are so many attempts to try something that will stick!  
Onychophagia has been shown to start as early as the age of 5.  
There are some interesting interventions I have come across and used in practice that are  worth noting.  
The first is a program that was performed by nurses in an elementary school.  The results of their study were published last year int he Journal of Specialty Pediatric Nurses. *  The program was called the “Do Not Bite Your Nails, Cut Your Nails” program.  299 students were observed by nurses over 6 weeks to see if this health promotion at a young age reduced nail biting.  In this study there were some impressive results of a drop from 83.9% of nail biters down to 6% after 6 weeks! There was no long term follow up noted but as with many habits - the goal is a stretch of time without the habit to break the cycle.  Intervening at an early age may be important to stop this habit from persisting through adulthood.
One of the most important things I assess amongst patients that come in with recurrent inflammation around the nails from nail biting and skin pulling or biting is to determine if part of the issue is the fact that excess skin or split nailshangs or sticks out from beside the nail.  Many times this dry peeling skin is just too tempting to pull or bite!  This peeling skin is usually the sign of a condition called chronic paronychia or swelling around the nail folds.  The swelling leads to peeling of the skin that can become chronic.  This is more common in people that pull or push their cuticles or outright remove their cuticles.  
Our cuticles are important to protect our nails.  One of the favorite treatment that works so consistently that i find its been life changing for many of my patients is relatively simple. I prescribe a combination cream that has a mild steroid and anti yeast agent in it.
Chronic paronychia has been shown to have an element of excess yeast that builds up in the nail fold.  I ask that my patients apply it twice daily around their nails folds for 2 weeks on then one week off for 6 weeks.  In addition to this, once weekly i ask that they create an “artificial cuticle” using Krazy glue around the crease where the nail meets the skin.  This creates a sealant that prevents further moisture from building up under the nail over the treatment time.  

After about 6 weeks of this intervention the peeling skin stops as the chronic paronychia  resolves and there just is no more dead skin to pick or peel.  This leave a lot more time for you to do more important things!

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