Beau’s lines. This disorder is characterized by horizontal depressions in most or all of the nails. These depressions occur at the proximal portion of the nail weeks after trauma, medication use, or illness interrupts nail formation. Chemotherapeutic agents, systemic illnesses such as syphilis, myocarditis, peripheral vascular disease, and uncontrolled diabetes, as well as illnesses associated with high fevers, such as scarlet fever, hand-foot-mouth disease, and pneumonia, have all been linked to Beau’s lines.2
The lines (usually one per nail) eventually move distally to the nail’s free edge. The nail on either side of the depression is normal in appearance.
Habit-tic-like dystrophy. Nail deformities that closely resemble habit-tic deformity on exam have been reported in patients who explicitly deny trauma. One report in the literature indicates that 2 patients who denied trauma—one with systemic lupus erythematous and another with no significant past medical history—responded to treatment with a multivitamin rich in biotin, vitamins B6, C, and E, and riboflavin.3 Another report describes habit-tic-like deformity that occurred in patients who were taking aromatic retinoids. The disorder resolved when the patients stopped taking the medication.1
Low-tech approach to treatment
The simplest approach to cosmetic improvement is to have the patient tape the proximal portion of the affected nails during the day when he or she picks at and rubs them. The tape acts as a barrier to the repetitive trauma and also serves as a reminder to the patient. The patient can expect improvement in several weeks if the tape is applied consistently. In addition, selective serotonin reuptake inhibitors (SSRIs) may play a role in treatment, because habit-tic deformity is believed to be a compulsive disorder.4
My patient tried the taping method for 2 months and had moderate improvement of his nail deformity. He was not, however, completely satisfied with the results, so we discussed vitamin supplementation as an additional therapy. His tour ended shortly thereafter, and he was lost to follow-up.
Disclosure
The author reported no potential conflict of interest relevant to this article. The opinions or assertions contained herein are the private views of the author and are not to be construed as official or as reflecting the views of the Department of Defense.
Correspondence
Edwin A. Farnell IV, MD, Urgent Care Clinic, Moncrief Army Community Hospital, 4500 Stuart Street, Fort Jackson, SC 29207-5720; edwin.farnell@gmail.com