Author Affiliations: Department of Dermatology, University of California, San Francisco (Mr Nguyen, Ms Wong, and Dr Koo); School of Medicine, University of Texas Health Science Center, San Antonio (Mr Nguyen); and School of Medicine, University of Utah, Salt Lake City (Ms Wong).
Vittorio and Phillips reported an interesting case of a 45-year-old man with a history of hand eczema who was successfully treated for habit-tic deformity with fluoxetine hydrochloride at 20 mg/d for 4 weeks. Selection of a selective serotonin reuptake inhibitor (eg, fluoxetine) in the treatment of this patient's condition was ideal, considering his personal and family history of depression. The authors highlighted the need for dermatologists to knowledgeably treat patients with habit-tic deformity, as such patients may prefer to be treated by dermatologists rather than by psychiatrists or their primary care providers.
Obsessive-compulsive disorder (OCD) spectrum includes conditions that bear features of but do not fit all of the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria for OCD. Habit-tic deformity, a common nail dystrophy induced by repeated picking at the proximal nail fold, illustrates how compulsion can be present in the absence of an obsessive component. The response of many OCD spectrum disorders to several medications, such as selective serotonin reuptake inhibitors or atypical antipsychotic agents (eg, risperidone), suggests a biochemical basis for these disorders. Even if a patient with a psychodermatologic complaint, such as habit-tic deformity, refuses to see a psychotherapist, any dermatology provider can help the patient with knowledgeable use of appropriate medications. This approach is likely to be more helpful than offering the patient no therapy at all.
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Contact Dr Koo at the Department of Dermatology, University of California, San Francisco, 515 Spruce St, San Francisco, CA 94118 (John.Koo@ucsfmedctr.org).
Nguyen TV, Wong JW, Koo J. Top Accessed Article: Treatment of Habit-Tic Deformity With Fluoxetine. Arch Dermatol. 2012;148(5):640. doi:10.1001/archdermatol.2012.320