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Habit-Tic Deformity — SCE Dermatology MCQ

Instant feedback + full explanation. One question, done properly.

HardPsychodermatologyHabit-Tic DeformitySCE Dermatology

A man has bilateral thumbnail washboard ridging, central depressions and loss of the cuticles from repeatedly rubbing each proximal nail fold. Fungal studies are negative. Which initial intervention directly targets the cause?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Barrier protection of the proximal folds with habit-reversal therapy

Explanation lettering: D = shown as A · E = shown as D · A = shown as E

D is correct. Habit-tic deformity results from repeated trauma to the proximal nail fold and underlying matrix, classically affecting both thumbnails. A barrier such as tape or a suitable dressing prevents access and provides a competing cue; habit-reversal strategies address the automatic behaviour. Improvement emerges with new nail growth, so it is not immediate. Intralesional corticosteroid is used for inflammatory matrix disease, terbinafine treats dermatophyte infection, and bilateral biopsy would add avoidable matrix injury in a characteristic presentation. Any associated anxiety, obsessive-compulsive symptoms or body-focused repetitive behaviours should be assessed without stigmatising the patient.

Reference: DermNet habit-tic nail deformity review: https://dermnetnz.org/topics/habit-tic-deformity