Client Health

Client of the Month: The Nail Biter

Clients who suffer from onychophagia (nail biting) can sustain a variety of problems ranging from infections to weakened teeth. Educate yourself about these conditions to help your clients take a bite out of their bad habit.

PSYCHOLOGICAL CAUSES: According to Web MD, 60% of children and 45% of teenagers bite their nails. It can continue into adulthood, but usually stops after age 18. Most often, nail biting is a manifestation of anxiety or stress. This can be severe, and the habit can be very difficult to stop without help from a mental-health professional.

DISFIGUREMENT: Nail biting can cause inflammation of the nail matrix, which can lead to “dystrophic” nails. These malformed nails often have horizontal ridging, depressions, and bumps. Biting can also lead to thin, peeling nails, as the cuticles become damaged and can’t maintain the nails’ moisture. If the nail biting continues long enough, the cuticles and matrix can become scarred, and nail dystrophy can become permanent.

INFECTIONS: Viral, bacterial, and yeast/fungal infections are a common problem among nail biters. The wart virus (HPV) is a common infection on the hands, and the virus has especially easy access to the traumatized nails of biters. “This can be problematic for several reasons,” says Chris G. Adigun, MD, board certified dermatologist. “Warts in the nail unit are notoriously difficult to treat. The warts easily spread from finger to finger among nail biters, as there are often small areas of trauma on multiple fingers. Warts on the hands and fingers are often distressing socially and professionally to those that contract them. And finally, biting the nails allows the wart to spread easily to the mouth and lips, which can also be quite unsightly and distressing.”

Bacterial infections that result from nail biting, such as staph and strep, can be both painful and serious. Even more serious are certain anaerobic bacterial infections that can cause abscesses that need to be drained surgically by a physician. If these abscesses are not drained, complete and permanent loss of the nail may occur.

Yeast infections, often of the candida species, are common among nail biters. These infections usually cause swelling around the nail and mild dystrophy. “In my nail practice, I see this almost every day,” says Dr. Adigun. “And it is nearly uniformly among nail biters and/or those with chronically manicured nails. It occurs due to chronic trauma/manipulation of the cuticles and surrounding skin of the nails, leading to chronic inflammation of those tissues. This permits candida species to proliferate in the small areas of trauma and inflammation. This can be easily treated with topical antifungal agents with good yeast coverage, often in conjunction with or preceded by a topical anti-inflammatory agent (topical steroid), and of course, abstaining from nail biting.”

DENTAL ISSUES: Chronic nail biting can also cause problems with an individual’s teeth. The biter’s teeth can shift or become disfigured in shape. Nail biters also suffer from higher rates of gum disease and infection.

Nail Biter’s Rx

Tips when performing manicures on nail biters:

> If your client has damaged cuticles from biting, or any signs of trauma, redness, or bitten cuticles or nails, Dr. Adigun advises that you wear protective latex or nitrile gloves. “If the nail biter has any signs of infection on any of the fingernails (redness, swelling, purulent drainage), do not perform services,” says Dr.  Adigun. Instead, refer the individual to a medical professional for treatment.

> For mild nail biters, suggest over-the-counter products, such as bitter tasting nail coatings that can help them break the habit. Encourage them to use cuticle oil after every hand washing and before bedtime.

> The thickness of acrylic enhancements can deter nail biters and help them become aware of the habit, which is sometimes unconscious. Gradually thin the acrylic with each successive manicure as they transition to gel-polish or natural nails.  

> Most people think nail biting is simply a harmless habit and are unaware of the risks. “Please do not ignore this habit when you see it,” Dr. Adigun says. “Address the issue and educate your clients. You can really make a difference and prevent serious infection!”

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