Question

Case Study #19

Six-year old Tiffany Burke has come to the pediatrician's office for treatment of an infection in the right hand. Her mother reports that Tiffany has been biting her fingernails since she was in preschool and has been poking her cuticles with pens or pencils since she was taken to get a French manicure. When you remove the adhesive bandage, you notice that the cuticle area is swollen and inflamed and there is evidence of purulent drainage on the bandage. The finger is tender when touched. There are slight red streaks extending from the cuticle up the finger. The mother says, "That wasn't there last night!"

What is the likely diagnosis for this scenario? How will you explain it to the mother?

What care will be given to resolve this condition?

Answer 1

Tiffany maybe having two diagnosis

1. Onychophagia

2. Dermatophagia

Tiffany's mother need to be explained that ;

Nail biting, also known as onychophagy or onychophagia (or even erroneously onyhophagia), is an oral compulsive habit. ... More pathological forms of nails biting are considered an impulse control disorder in the DSM-IV-R and are classified under obsessive-compulsive and related disorders in the DSM-5

Dermatophagia is a psychological condition in which a person compulsively bites, chews, gnaws, or eats their skin. It often affects the skin around people's fingers

Care need to be taken to stop nail biting are as follows;

1. Keep your nails trimmed short. Having less nail provides less to bite and is less tempting.

2. Apply bitter-tasting nail polish to your nails. Available over-the-counter, this safe, but awful-tasting formula discourages many people from biting their nails.

3. Get regular manicures. Spending money to keep your nails looking attractive may make you less likely to bite them. Alternatively, you can also cover your nails with tape or stickers or wear gloves to prevent biting.

4. Replace the nail-biting habit with a good habit. When you feel like biting your nails, try playing with a stress ball or silly putty instead. This will help keep your hands busy and away from your mouth.

5. Identify your triggers. These could be physical triggers, such as the presence of hangnails, or other triggers, such as boredom, stress, or anxiety. By figuring out what causes you to bite your nails, you can figure out how to avoid these situations and develop a plan to stop. Just knowing when you’re inclined to bite may help solve the problem.

6. Try to gradually stop biting your nails. Some doctors recommend taking a gradual approach to break the habit. Try to stop biting one set of nails, such as your thumb nails, first. When that’s successful, eliminate your pinky nails, pointer nails, or even an entire hand. The goal is to get to the point where you no longer bite any of your nails.

Care to be taken to stop peeling skin around the nails are as follows;

1. Create a physical barrier.

Attempting to stop picking with sheer willpower alone is definitely not a good approach, and you'll only set yourself up for disappointment. But there are some very practical things you can do to heal damaged tissue and help break the cycle—like wearing a bandage over the cuticles you tend to pick.

2. Keep your cuticles hydrated.

Sometimes, the slightest frayed cuticle may trigger an all-out picking binge.Using an oil to keep your cuticles hydrated and prevent the rough or frayed skin that may prompt picking.

3. Move your body.

“One theory is that picking is a self-regulating behavior—it stimulates us when we are bored or sedentary (watching TV, at the computer, talking on the phone), and calms us when we are overstimulated (whether by negative emotions or stress, or positive excitement),"If you tend to pick more during stressful events or periods in your life, any means of lowering your cortisol levels and increasing endorphins and other feel-good, healing molecules can help bring you relief and curb your urge to pick.This can be accomplished with anything from stretching to jogging to yoga to visiting a friend to having sex. Basically, to pick less, move your body more.

4. Notice (and release) negative thoughts and sensations.

If your picking habit is a conscious behavior that happens when you experience intense negative emotions, "try to understand that something is affecting you in the moment that needs to be released,""Bring your attention to your body, then breathe in deeply through your nose and breathe out slowly through your mouth, allowing this release to happen in a different, more caring way."

5. Find a healthier way to keep your hands busy.

For people who tend to pick mindlessly, and not necessarily as a result of obvious negative emotions, a good strategy is to "do something else that involves the same muscle as the skin-picking behavior,"

For example, instead of moving your fingers toward your cuticles to pick, try clenching a specific object like a stress ball, digging your fingernails into Silly Putty or a piece of clay (which is surprisingly satisfying), or applying pressure gently on a specific part of your body to reduce the urge to pick. If you tend to bite your cuticles as well, try chewing gum or always having a drink to sip on.

6. Try an N-acetylcysteine supplement.

While there's no magic pill for cuticle picking, one supplement may help. A 2016 study found that taking a 1,200-mg daily dose of N-acetylcysteine (NAC) helped skin picking behavior in 47% of patients with excoriation (or skin picking) disorder, likely due to NAC's ability to affect mood-regulating neurotransmitters.*

"Due to its beneficial actions on glutamate and dopamine, NAC can be an effective part of treatment for behavioral disorders,"

7. If things don't improve, consider cognitive behavioral therapy.

"If someone is maiming themselves, scarring themselves, having multiple bouts of infections, and still can't stop picking, then that's a problem. There's a positive feedback loop in your brain that has to be broken,"

Severe picking can be considered a form of obsessive-compulsive disorder called excoriation or dermatillomania. In these cases, a more significant intervention may be needed, and all the experts I spoke with agreed that cognitive behavioral therapy (CBT) was it.

In broad terms, CBT involves working with a practitioner to identify the thoughts you're having while picking or engaging in any unwanted behavior and replacing them with healthier thoughts. "But it only works if you're motivated,"

8. Reward yourself with a manicure.

Once you start making some progress, rewarding yourself with a manicure can actually be a pretty effective strategy, says Wechsler. Seeing those smooth cuticles and polished nails might be just the motivation you need to keep up the healthy habits.

Thank you......