A 27-year-old female with past medical history of asthma , hypothyroidism, and depression presented with bilateral distortion of her thumbnails that started 2–3 years prior. She said that the base of her thumbnails started to “bubble,” which then seemed to resolve on it’s own until about 2 months prior. The thumbnail symptoms then began to recur, and were more severe again at the time of this visit, with parts of the thumbnails “tearing off.”

Vitals were normal. On exam, the bases of her bilateral thumbnails featured deep grooves, some erosion, and dipping and spooning.

Fungal infection was considered, but the nails did not appear typical of onychomycosis. The patient was referred to dermatology , and photos were sent to a dermatologist who said it looked like there had been trauma to the nails. The patient had not mentioned anything about trauma when she presented, but when later asked whether she picked at her nails or cuticles, she described herself as a “voracious nail picker.”