Differential Diagnosis for Skin Tears at Proximal Aspects of Nail Bed

• Single Most Likely Diagnosis
  • Onychotillomania: This condition involves compulsive picking or tearing at one's own nails, often resulting in skin tears around the nail bed, including the proximal aspects. The behavior can be a manifestation of anxiety, stress, or other psychological factors.
• Other Likely Diagnoses
  • Onychophagia: Similar to onychotillomania, onychophagia involves biting one's nails, which can lead to skin tears around the nail bed due to the biting action.
  • Nail biting or picking due to anxiety or stress: Individuals under stress or with anxiety disorders may exhibit nail biting or picking behaviors, leading to skin tears.
  • Eczema (Dyshidrotic): This condition can cause small blisters on the hands or feet, which can lead to skin tears, especially if the blisters rupture and the skin is further irritated.
• Do Not Miss Diagnoses
  • Squamous Cell Carcinoma: Although rare, skin cancers like squamous cell carcinoma can present with non-healing lesions or tears, especially in sun-exposed areas or in individuals with a history of skin cancer.
  • Infection (Bacterial or Fungal): Infections around the nail bed can cause inflammation, pain, and potentially skin tears, especially if an abscess forms and ruptures.
• Rare Diagnoses
  • Darier's Disease: A rare genetic disorder that affects the skin, leading to abnormal keratinization. It can cause skin lesions and potentially tears, especially in areas like the nail bed.
  • Epidermolysis Bullosa: A group of genetic conditions that result in fragile skin and blisters, which can lead to skin tears with minimal trauma, including around the nail bed.