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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 5 to 29 of 29. Go back in thread:
Posted by Bizzyliz on June 21, 2003, at 1:09:38
In reply to Re: Cuticle destruction, posted by McPac on June 21, 2003, at 0:45:27
I have a sister, 39, who has been doing this since she was a child. Strange as it may seem, the only thing that helps is keeping acrylic nails on. She takes Prozac, but that doesn't help the cuticle-picking.She says that with the artificial nails she can't get to the cuticles. When she goes without them, her cuticles on all her fingers stay bloody. Depression and bipolar run in our family. I also have a good friend with a history of depression in her family and she has an aunt with the same "habit."
Posted by Sabina on June 21, 2003, at 1:10:21
In reply to Re: Cuticle destruction, posted by McPac on June 21, 2003, at 0:45:27
I'm not trying to be a "smarty pants" but I was under the impression that trichotillomania referred solely to hair related picking/pulling? Not that it's name really matters, just to clarify in case 2em wants to look into it more on the web.
Posted by HenryO on June 21, 2003, at 3:46:55
In reply to Re: Cuticle destruction » McPac, posted by Sabina on June 21, 2003, at 1:10:21
Wow, I never thought about it as a bio-psych condition before. My father has those bandages on his fingers all the time, for 40 years. I have always considered it a bad habit on the rare occasions I even think about it. I believe I read years ago someplace that trichotillomania (correct spelling), if thats what this is, was caused by some nutritional/mineral deficiency. That's probably a load of poo. Do you have any weird cravings that other people find odd? I know parrots deprived of certain essential elements pull all their feathers out. In the wild they flock to and consume certain kinds of earth. (getting pretty far a field here) I've long known my father ought to be on meds. I'd love to know more about this.
Posted by McPac on June 21, 2003, at 15:07:11
In reply to Re: Cuticle destruction, posted by HenryO on June 21, 2003, at 3:46:55
trichotillimania has long been regarded as being along the ocd spectrum; some now refer to it as an impulse control disorder; hair-pulling is example most commonly thought of when hearing the word "trichotillimania", though skin-picking, scab-picking, etc. can be also from what I recall
Posted by indivmed on June 21, 2003, at 15:33:19
In reply to Re: Cuticle destruction, posted by McPac on June 21, 2003, at 15:07:11
Hmmm...And here I was thinking that I was just bored as hell. Oh, and one more thing, I'm going to slap the hell out of the next person that tells me to "get that stuff at the store" that makes your nails/cuticles taste bad when you bite them. To me, that "stuff" is as mythical as a freakin' unicorn.
Posted by Temmie on June 21, 2003, at 16:45:26
In reply to Cuticle destruction, posted by 2em on June 20, 2003, at 22:17:27
Oh, I understand this malady ... although my biting and tearing at the flesh around my fingertips -- at least at this point -- is primarily limited to nervous response watching scary movies. I've long threatened to write an article or book about this one day (tentative title, "A break in the skin"), as the number of damaged fingers usually provides good indication as to height and depth of stress level. I did a google search on this some time ago and found some links to self-mutilating. Gee. I never thought of it in quite those terms -- although there are certain elements (standing up to the pain of tearing one's own flesh) that one associates with "cutting." I'm surprised your therapists haven't been more helpful. Thank goodness for the support you will surely find here! In the meantime, I slice bandaids down the middle, use A&D ointment, and find the slender appearance of half a bandaid seems a little less noticeable and rarely invites comments. Then, too, the problem seems to be passing for me. Wishing you the same! XXX, Temmie
Posted by Temmie on June 21, 2003, at 16:54:04
In reply to Re: Cuticle destruction, posted by Temmie on June 21, 2003, at 16:45:26
Hmmmm. Just read through the rest of the replies here, and looks like you've had lots of solid guidance. I also have a history of bi-polar in my family, although for me it presents as depression (w/ PTSD and anxiety). I have been biting at/digging at my fingernails since I was little. I have now damaged the nail bed on both tumbs, and my nails grow in with ridges, and generally split. Perhaps this will be a deterrant to you (ugly nails on top of bloody fingers). In the meantime, follow the many leads you've gotten here and good luck! T.
Posted by noa on June 21, 2003, at 21:29:55
In reply to Re: Cuticle destruction, posted by Temmie on June 21, 2003, at 16:54:04
I have this with skin on face and scalp. SI doesn't feel like it fits. But trich does feel like it fits. It feels to me very much like a tic or something similar. For me, it is worse on my ADs, I think. although I've been on ADs for so long now, who knows. Pdocs don't seem to have any answers.
Posted by McPac on June 22, 2003, at 0:19:10
In reply to Re: Cuticle destruction, posted by noa on June 21, 2003, at 21:29:55
Last I'd read (few yrs back), lithium seemed to be showing some effectiveness for trich.
Posted by fuji on June 22, 2003, at 9:31:38
In reply to Re: Cuticle destruction, posted by noa on June 21, 2003, at 21:29:55
I ignored the topic when I first saw it but decided to read it anyway. Wow, I pick and chew my fingers till they are raw and can't remember a time I haven't done so. I do the hair thing when my hair is long but when it's short I usually don't bother with it but will occassionally do the pubic hair pull. I pick and squeeze pimples that have nothing left in them and yet I continue to do it until it of course hurts and scabs & then I start picking and start it over again. Fortunately, I don't do it on my face but anywhere else I get little pimples and I can reach them!! I always thought that the compulsion to nibble and chew the hell out of my hands was better than when I smoked (4-5 packs a day), drank & did drugs. Of course I did all of those things while still chewing & picking. Oh yea, and I also pick and cut my toenails & skin around my toes so they too look like they have been through a war but I can't seem to stop once I start!!! After reading what I just wrote I think I need to be locked up or heavily sedated. Oh yeah, also I take effexer, prozac & just started back on provigil. Better living through legal chemistry!!
Posted by 2em on June 22, 2003, at 12:28:43
In reply to Re: Cuticle destruction (longish), posted by fuji on June 22, 2003, at 9:31:38
Thank you all for the insight to this. It
is definitely, good to know that there are
others who have experienced this. I looked up
trichotillomania in the DSM and its diagnosis
does not pertain to fingers, just hair. Which
of course does not mean that it is not related.
The connection with self-mutilation is something
I have not considered and feels more right. It
does feels compulsive but I have never had any
other indications of OCD. I didn't mean to
imply that my therapist or Pdoc were dolts just
that there doesn't seem to be a wealth of info
out there on this particular behavior. As my
therapist said there are alot more harmful ways
that anxiety could manifest itself than just
picking at my cuticles.
Posted by noa on June 22, 2003, at 12:36:51
In reply to Re: Cuticle destruction (longish), posted by 2em on June 22, 2003, at 12:28:43
has anyone notice an increase of these behaviors while on any medications?
I think mine is worse on meds.
Posted by Eeyore on June 22, 2003, at 14:08:53
In reply to Cuticle destruction, posted by 2em on June 20, 2003, at 22:17:27
I thought I was the only one! I also bite and pull at my cuticles till they bleed on my fingers and toes. I also have the habit of picking at the skin on my heels, then peeling the skin till it bleeds. Try to explain that to anyone!
The only thing that even seems to help a bit is to get really good hand cream, and using it at least twice a day so the cuticles aren't so tempting.
I always leave my pdoc with bleeding cuticles. She has never commented, so I'm not sure if it's because she doesn't notice or if she just doesn't want to discuss it?
Posted by Eddie Sylvano on June 22, 2003, at 15:18:02
In reply to Cuticle destruction, posted by 2em on June 20, 2003, at 22:17:27
>In times of high stress I will pick until I bleed. I have shared this with my therapist and psychiatrist but neither have seemed too concerned with the habit.
----------------I posted almost the exact same topic a month ago. Within the last year or so I've taken to tearing out shreds of cuticle around my thumb, which created more shards of skin/cuticle, which prompted more tearing, eventually altering the skin and nail border on my thumb. I do it almost unconciously, running a fingernail under a bit of skin along the side of the nail, and seperating it from the underlying skin.
I don't know why I do this. It's relaxing, in some odd sort of way, I guess. It's not any desire to test reality via pain or all that. I too mentioned it to my doctor, who was also wholly unimpressed with my concern. I think that doctors only take interest in things if they've been taught to, and that's a pretty narrow range of knowledge. Left to explain it myself, then, I can only assume it serves a self-stimulatory and relaxation purpose. I also fidget a lot (mostly constant leg or foot shaking), which I feel fulfills the same end. Still, I'm not a doctor, so I can't do much to address it medically. I just try to keep my nails short, so I can't work them in under my skin (and then I miss doing it).
Posted by Emme on June 22, 2003, at 16:59:58
In reply to Cuticle destruction, posted by 2em on June 20, 2003, at 22:17:27
Hi. I do it to some degree. Definitely more when I'm stressed. And more so in the wintertime because dry cuticles are easier to pick at. In the summer my hands don't look so bad. I'm going to try using cuticle oil to keep them more supple and less tempting to pick at. And the more moisturized my skin is, the faster it heals. I know this suggestion isn't a cure for what you're experiencing, but maybe it'll help reduce it a teeny bit...? Good luck.
Emme
Posted by Temmie on June 22, 2003, at 17:48:37
In reply to Re: Cuticle destruction » 2em, posted by Emme on June 22, 2003, at 16:59:58
Who would have thought there were so many with the same problem? I agree with the note above, keeping your cuticles moisturized helps. I used to keep a dish of olive oil by the sink in my bathroom, and would give my fingers a soak after washing my hands (wiping off the extra on a towel). Also, I had acrylic put over my nails at one point (until the upkeep became too $$$), and when my nails were long and strong, my cuticles were great. Lastly, it's hard to think of our bodies as "temples" or "vehicles" we should care for when tearing is so tempting ... but perhaps this will help. Good luck! (In search of a nail clipper to trim the cuticle I bit at today). Temmie
Posted by 2em on June 22, 2003, at 22:24:42
In reply to Re: Cuticle destruction » 2em, posted by Eddie Sylvano on June 22, 2003, at 15:18:02
That is it almost exactly, right down to the
constant leg motion, well not totally constant,
I mean my legs aren't pumping right now. I agree
that it fulfills some need. There is something
very satisfying when I can get a piece of dead
skin off without causing bleeding. And the
tearing seems to result in more dead skin so it
is self-perpetuating. I dont think it really has
to do with causing pain. After a couple decades
of this (and a year and a half washing dishes in
a restaurant) I think the nerve endings in my
finger-tips have become much less sensitive.
Shorter finger-nails and lotions is probably
the best remedy.
Posted by elleff on June 23, 2003, at 4:35:36
In reply to Re: Cuticle destructionEddie, posted by 2em on June 22, 2003, at 22:24:42
It's interesting to read the posts of so many who are afflicted in the same graphically awful ways. I have also had this problem since at least my early teenage years - and pretty continuously for 30 or so years thereafter. For me it's also associated, more episodically, with severe chewing of the inside of my lips and cheeks.
I made a serendipitous discovery last year that might be useful to some: Selegiline almost completely stops my cuticle, nail and lip destruction, whereas nothing else has ever made any difference. Selegiline (at 15mg per day) also, for me, works better for my ADD and atypical depressive symptoms than anything else I've tried for either. I've had, over the past 15 years or so, pretty adequate trials of TCAs, nonselective MAOIs, and SSRIs for depression. Parnate was definitely the best of these for me as I'm sure it helped my ADD symptoms very well long before I recognised that I had them. After these were recognised in syndromal form a few years ago I was given a trial of Ritalin (which I found mind-bendingly mentally slowing) and Dexamphetamine (which was considerably better). I don't however like the "speedy" feeling of DA particularly and, in retrospect Parnate felt pretty similar. There is a strong history of ADD in my family - I'm certainly not the most outstanding case. As well, though no-one has Tourette's Syndrome in full form, many of us have motor tics and what I would think of as an array of unusual "habit spasms", mostly involving our hands. I'm the only severe nail and cuticle biter.
I tried Selegiline after tracking down a few papers which suggested it worked very well for patients with combined ADHD and Tourette's Syndrome, eg. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8442708&dopt=Abstract
In this paper Jankovic mentions that 21 of 26 patients with this combined disorder reported that selegiline (5-15mg per day) was better than either Ritalin or Dexamphetamine. That's certainly my experience too. The really surprising thing was that my nail and cuticle chewing went down 95% too!
It may be irrelevant, but it's certainly interesting to note that there is a congenital mental retardation syndrome with is characterised by awful chewing mutilation of lips and hands (ie. not just nails and cuticles, but also fingertips and even whole fingers): Lesch-Nyhan Syndrome which results from homozygous deficiency of the enzyme hypoxanthine guanine phosphoribosyltransferase, an enzyme in the purine salvage pathway. Don't ask me how, but the resulting metabolic abnormality causes severe deficiencies in development of dopaminergic pathways in the developing brain, eg see http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11882343&dopt=Abstract
Maybe it's the case that in some people cuticle chewing is a manifestation of dopaminergic or phenyethylaminergic dysfunction. Certainly Selegiline has worked well for me and I've be interested in hearing of any other similar or contrary experiences.
elleff
Posted by theo on June 23, 2003, at 9:24:04
In reply to Cuticle destruction, posted by 2em on June 20, 2003, at 22:17:27
What meds are you taking??
Posted by Letitia Shen on June 23, 2003, at 13:54:59
In reply to Re: Cuticle destruction, posted by theo on June 23, 2003, at 9:24:04
Hello, I pick my fingers, here is the degree which I did it
Hi Stress, mother with cancer - 5 fingers.
Hi Stress, demanding college degree - All 10 fingers bloody.
Medium Stress, demanding job after college - 5 Fingers, no blood.
Better Job - 2 fingers, no blood.
Now, low stress - 2 fingers, no blood.I am on regular Effexor now and I have 2 fingers that are not too notieable, no blood. Creamy Vasaline really helps. It isn't as slimy as regular vasaline and absorbs really fast. I was amazed. I think that my finger picking starts with stress, then it becomes medical. It itches when it heals. Now it is just a habit. I don't pick my fingers if I my hands are busy, ie. cook, clean, type on keyboard. I do pick when I am stoped at a red light, or watching a boring movie. I guess it is part of my nature to always be busy. When I painted my nails, I definitely didn't pick my fingers.
Or it could be a combination of habit and fungus. At one time the over the counter foot fungus medications worked and less itchy, but I started picking again.
Summary/Suggestion:
1. Try creamy vasaline.
2. If it is itcy, try hydrocortizone cream over the counter. Or try the foot fungus creams. It is cheap and you never know, it could have been a type of fungus all this time.
3. Try not to take on too much stress. I have to learn to say no. Or not volunteer.
4. Once your hands start to heal, try to journal and chart the conditions when you are picking.
5. Paint your nails.
6. Let us know what works.Good Luck, Letitia
Posted by KimberlyDi on June 23, 2003, at 16:05:14
In reply to Cuticle destruction, posted by 2em on June 20, 2003, at 22:17:27
I've known several people with that nervous habit, including my husband. I've never heard of any social stigma attached to nail biting. You now have a diagnosis and I guess you are being treated for it. Don't worry about it so
much. Take care of the anxiety first, then rest will follow.
Good luck!
Kim> I was recently diagnosed with GAD. Throughout
> the past 15+ yrs I have had a "nervous-habit" of picking at my cuticles such that at this point in my life I am ashamed for people to see the state
> of my fingers. In times of high stress I will pick until I bleed. I have shared this with my therapist and psychiatrist but neither have seemed too concerned with the habit. A big part of my anxiety stems from social interactions and a particular anxiety is that someone might notice that I frequently have bandages on my finget-tips or that there are scabs around my finger-nails.
> Does anyone share this malady or know anything about this particular reaction to anxiety. I would search the archives here but thought I might just post on this to save time.
Posted by noa on June 23, 2003, at 20:24:54
In reply to Re: Cuticle destruction - try selegiline, posted by elleff on June 23, 2003, at 4:35:36
Thanks again for the refs.
Posted by Temmie on June 23, 2003, at 21:40:01
In reply to Re: Cuticle destruction - try selegiline » elleff, posted by noa on June 23, 2003, at 20:24:54
Help. Am trying to get off this post. Interesting stuff, but I'm done. Am hoping if I post this and DON'T check the "notify you of later follow-ups" that will break the cycle. Best wishes everyone. Wishing you all happy fingers! Temmie
Posted by jemma on June 24, 2003, at 10:22:43
In reply to Re: Cuticle destruction - try selegiline, posted by elleff on June 23, 2003, at 4:35:36
Hi elleff -
Did you find that at 15 mg of selegiline you had to follow an MAOI diet? I considered trying 15 mg, but held back at 10 to avoid the diet.
- Jemma
Posted by elleff on June 24, 2003, at 18:42:51
In reply to Re: Cuticle destruction - try selegiline » elleff, posted by jemma on June 24, 2003, at 10:22:43
> Hi elleff -
>
> Did you find that at 15 mg of selegiline you had to follow an MAOI diet? I considered trying 15 mg, but held back at 10 to avoid the diet.
>
> - JemmaHi Jemma
No, I don't follow the MAOI diet & have had no trouble eating cheese etc. I should point out however that I do weigh about 100kg and am about 187cm - ie not a small fellow - so on a mg per kg basis 15mg for me might be equivalent to 10mg for a smaller person. Whilst on Parnate years ago I did experience a hypertensive reaction (to someone's homemade chocolate sauce with nuts which I suspect hadn't been stored too carefully), so I am familiar with the symptoms of such a reaction. Naturally I am careful, even on this dose of Selegiline, to avoid all medications (including pseudoephedrine) that could cause hypertensive reactions.
Another point that I should have mentioned in my earlier post is that I have been trialing, on and off, the addition of l- and dl-phenylalanine in varying doses to the selegiline. Several studies have suggested that such combinations have antidepressant effects, and various people have speculated that their might be also be benefits as regards ADD symptoms too. For what it's worth my impression is that l-phenylalanine in the range 500 - 1000mg per day (taken along with a multivitamin containing 50mg of Vit B6) on an empty stomach first thing in the morning probably enhances the effect of Selegiline. dl-phenylalanine is probably similarly useful, however I suspect it is somewhat sedating, presumably because of the inhibiting effect of d-phenylalanine on enkephalinase.
regards
elleff
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