Dermoscopic features of onychotillomania: A study of 36 cases.

BACKGROUND: Onychotillomania is a nail-picking disorder characterized by nail dystrophy and abnormal morphology of the nail plate, nail bed, and periungual skin. OBJECTIVE: The purpose of this study was to describe the dermoscopic features of onychotillomania. METHODS: A retrospective study of the dermoscopy images of 36 patients affected by onychotillomania. The images were reviewed independently by both authors and a list of dermatoscopic findings was established. RESULTS: Scales were observed in 34 cases (94.4%). Absence of the nail plate was seen in 30 cases (83.3%). Wavy lines were observed in 25 cases (69.4%). Hemorrhages were observed in 23 cases (63.9%). Crusts were seen in 22 cases (61.1%). Nail bed pigmentation was observed in 17 cases (47.2%). Speckled dots were observed in 14 cases (38.9%). Nail plate melanonychia was observed in 4 cases (11.1%). LIMITATIONS: Limitations included small sample size and retrospective study. CONCLUSION: Absence of the nail plate with multiple obliquely oriented nail bed hemorrhages, nail bed gray pigmentation, and presence of wavy lines are characteristic findings of onychotillomania and not seen in other nail diseases.