What is the cause of nail pulling, also known as onychotillomania (nail picking) or onychophagia (nail biting)?

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Differential Diagnosis for Nailed Pulling Up

  • Single most likely diagnosis
    • Onychocryptosis (Ingrown Toenail): This condition is characterized by the nail growing into the surrounding skin, leading to pain, swelling, and sometimes infection. Pulling up on the nail can be a symptom or an attempt to relieve discomfort.
  • Other Likely diagnoses
    • Onychauxis (Thickened Toenail): Thickening of the toenail can cause discomfort and may lead to the sensation of the nail pulling up due to pressure on the nail bed.
    • Paronychia: An infection around the nail can cause pain and swelling, potentially leading to the sensation of the nail pulling up.
    • Onycholysis (Nail Lifting): This condition involves the separation of the nail from the nail bed, which can feel like the nail is pulling up.
  • Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
    • Osteomyelitis: Although rare, an infection of the bone beneath the nail can present with similar symptoms and requires prompt treatment to avoid serious complications.
    • Squamous Cell Carcinoma: A type of skin cancer that can occur under the nail, presenting with pain, swelling, or changes in nail appearance, including the sensation of the nail pulling up.
  • Rare diagnoses
    • Subungual Melanoma: A rare and aggressive form of skin cancer that occurs under the nail, which can cause changes in nail appearance or sensation, including pulling up.
    • Nail Psoriasis: An autoimmune condition that can affect the nails, leading to thickening, lifting, or other changes that might feel like the nail pulling up.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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