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Onychotillomania

MedGen UID:
65438
Concept ID:
C0233623
Mental or Behavioral Dysfunction
Synonym: Onychotillomania (pulling out nails)
SNOMED CT: Onychotillomania (60259009); Neurotic picking at nails (60259009)
 
HPO: HP:0032509

Definition

Onychotillomania is characterized by the compulsive or irresistible urge in patients to pick at, pull off, or harmfully bite or chew their nails. [from HPO]

Term Hierarchy

CClinical test,  RResearch test,  OOMIM,  GGeneReviews,  VClinVar  
  • CROGVOnychotillomania

Conditions with this feature

Smith-Magenis syndrome
MedGen UID:
162881
Concept ID:
C0795864
Disease or Syndrome
Smith-Magenis syndrome (SMS) is characterized by distinctive physical features (particularly coarse facial features that progress with age), developmental delay, cognitive impairment, behavioral abnormalities, sleep disturbance, and childhood-onset abdominal obesity. Infants have feeding difficulties, failure to thrive, hypotonia, hyporeflexia, prolonged napping or need to be awakened for feeds, and generalized lethargy. The majority of individuals function in the mild-to-moderate range of intellectual disability. The behavioral phenotype, including significant sleep disturbance, stereotypies, and maladaptive and self-injurious behaviors, is generally not recognized until age 18 months or older and continues to change until adulthood. Sensory issues are frequently noted; these may include avoidant behavior, as well as repetitive seeking of textures, sounds, and experiences. Toileting difficulties are common. Significant anxiety is common as are problems with executive functioning, including inattention, distractibility, hyperactivity, and impulsivity. Maladaptive behaviors include frequent outbursts / temper tantrums, attention-seeking behaviors, opposition, aggression, and self-injurious behaviors including self-hitting, self-biting, skin picking, inserting foreign objects into body orifices (polyembolokoilamania), and yanking fingernails and/or toenails (onychotillomania). Among the stereotypic behaviors described, the spasmodic upper-body squeeze or "self-hug" seems to be highly associated with SMS. An underlying developmental asynchrony, specifically emotional maturity delayed beyond intellectual functioning, may also contribute to maladaptive behaviors in people with SMS.

Professional guidelines

PubMed

Lee DK, Lipner SR
Int J Environ Res Public Health 2022 May 24;19(11) doi: 10.3390/ijerph19116370. PMID: 35681955Free PMC Article
Lee DK, Lipner SR
Int J Environ Res Public Health 2022 Mar 13;19(6) doi: 10.3390/ijerph19063392. PMID: 35329078Free PMC Article
Halteh P, Scher RK, Lipner SR
Am J Clin Dermatol 2017 Dec;18(6):763-770. doi: 10.1007/s40257-017-0289-6. PMID: 28488241

Recent clinical studies

Etiology

Starace M, Cedirian S, Alessandrini A, Bruni F, Piraccini BM, Iorizzo M
Ann Dermatol Venereol 2023 Dec;150(4):253-259. Epub 2023 Oct 7 doi: 10.1016/j.annder.2023.05.005. PMID: 37813711
Lee DK, Lipner SR
Int J Environ Res Public Health 2022 May 24;19(11) doi: 10.3390/ijerph19116370. PMID: 35681955Free PMC Article
Maddy AJ, Tosti A
J Am Acad Dermatol 2018 Oct;79(4):702-705. Epub 2018 Apr 14 doi: 10.1016/j.jaad.2018.04.015. PMID: 29660424
Pacan P, Grzesiak M, Reich A, Kantorska-Janiec M, Szepietowski JC
Acta Derm Venereol 2014 Jan;94(1):67-71. doi: 10.2340/00015555-1616. PMID: 23756561
Koo JY, Smith LL
Pediatr Dermatol 1991 Jun;8(2):107-13. doi: 10.1111/j.1525-1470.1991.tb00296.x. PMID: 1923977

Diagnosis

Lee DK, Lipner SR
Int J Environ Res Public Health 2022 Mar 13;19(6) doi: 10.3390/ijerph19063392. PMID: 35329078Free PMC Article
Nwankwo CO, Jafferany M
Dermatol Ther 2019 Sep;32(5):e13073. Epub 2019 Sep 4 doi: 10.1111/dth.13073. PMID: 31444827
Gupta MA, Gupta AK
Clin Dermatol 2019 May-Jun;37(3):268-277. Epub 2019 Jan 11 doi: 10.1016/j.clindermatol.2019.01.006. PMID: 31178108
Halteh P, Scher RK, Lipner SR
Am J Clin Dermatol 2017 Dec;18(6):763-770. doi: 10.1007/s40257-017-0289-6. PMID: 28488241
Rieder EA, Tosti A
J Am Acad Dermatol 2016 Dec;75(6):1245-1250. Epub 2016 Jul 26 doi: 10.1016/j.jaad.2016.05.036. PMID: 27473457

Therapy

Lee DK, Lipner SR
Int J Environ Res Public Health 2022 May 24;19(11) doi: 10.3390/ijerph19116370. PMID: 35681955Free PMC Article
Nwankwo CO, Jafferany M
Dermatol Ther 2019 Sep;32(5):e13073. Epub 2019 Sep 4 doi: 10.1111/dth.13073. PMID: 31444827
Gupta MA, Gupta AK
Clin Dermatol 2019 May-Jun;37(3):268-277. Epub 2019 Jan 11 doi: 10.1016/j.clindermatol.2019.01.006. PMID: 31178108
Adil M, Amin SS, Mohtashim M
Indian J Dermatol Venereol Leprol 2018 Nov-Dec;84(6):652-659. doi: 10.4103/ijdvl.IJDVL_33_18. PMID: 30246706
Halteh P, Scher RK, Lipner SR
Am J Clin Dermatol 2017 Dec;18(6):763-770. doi: 10.1007/s40257-017-0289-6. PMID: 28488241

Prognosis

Nwankwo CO, Jafferany M
Dermatol Ther 2019 Sep;32(5):e13073. Epub 2019 Sep 4 doi: 10.1111/dth.13073. PMID: 31444827
Maddy AJ, Tosti A
J Am Acad Dermatol 2018 Oct;79(4):702-705. Epub 2018 Apr 14 doi: 10.1016/j.jaad.2018.04.015. PMID: 29660424
Grzesiak M, Pacan P, Reich A, Szepietowski JC
Acta Derm Venereol 2014 Nov;94(6):745-6. doi: 10.2340/00015555-1805. PMID: 24514910
Gupta MA
Clin Dermatol 2013 Jan-Feb;31(1):110-7. doi: 10.1016/j.clindermatol.2011.11.015. PMID: 23245982

Clinical prediction guides

Aljhani S
J Med Case Rep 2022 Nov 20;16(1):431. doi: 10.1186/s13256-022-03652-9. PMID: 36403006Free PMC Article
Maddy AJ, Tosti A
J Am Acad Dermatol 2018 Oct;79(4):702-705. Epub 2018 Apr 14 doi: 10.1016/j.jaad.2018.04.015. PMID: 29660424
Gropman AL, Duncan WC, Smith AC
Pediatr Neurol 2006 May;34(5):337-50. doi: 10.1016/j.pediatrneurol.2005.08.018. PMID: 16647992
Greenberg F, Guzzetta V, Montes de Oca-Luna R, Magenis RE, Smith AC, Richter SF, Kondo I, Dobyns WB, Patel PI, Lupski JR
Am J Hum Genet 1991 Dec;49(6):1207-18. PMID: 1746552Free PMC Article

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