Alteration of the nail itself

This category includes: 1 Self-inflicted injury (Figures 9.45-9.47):

• the habit of pushing back the cuticle (see Chapter 2)

• Heller's median nail dystrophy (see Chapter 2)

• nail biting and picking

• self-inflicted nail damage—may cause longitudinal melanonychia (LM)

• nail artefacts, caused by deliberate acts of injury to the nail apparatus with the intention of creating a 'diversion for personal gain'; they may also be caused 'subconsciously'. Nail artefacts take various forms. Such patients usually have psychological problems.

Figure 9.45

Self-induced transverse ridges/furrows.

Figure 9.45

Self-induced transverse ridges/furrows.

Figure 9.46

Onychotillomania of the great toe.

Figure 9.46

Onychotillomania of the great toe.

Figure 9.47

Nail dystrophy—self-damage.

Figure 9.47

Nail dystrophy—self-damage.

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