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60-year-old with change in thumbnail appearance
Last reviewed: December 2022
Author: Dr Ian Coulson, Consultant Dermatologist and Editor-in-Chief, 2022.
Edited by the DermNet content department
Background
This 60-year-old man has noticed a change in the appearance of one thumbnail. The rest of his nails are normal and there is no history of skin disease.
What physical signs do you see?
There is wrinkling and rippling of the central portion of the nail plate, also there is loss of the cuticle at the proximal nail fold.
What is the likely diagnosis and cause?
This is a habit-tic nail deformity. It is caused by frequent subconscious picking of the proximal nail fold either from the adjacent or the contralateral index finger. The repetitive pushing back of the cuticle results in minor trauma to the nail matrix; secondary rippled central dystrophy subsequently develops.
How can it be treated?
The affected patient is often unaware of the habit but is often appreciated by spouses or other family members. Applying a hydrocolloid dressing around the nail including the proximal nail fold can break the habit, allowing the nail to regrow normally.