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Habit tic deformity secondary to guitar playing

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Habit tic deformity secondary to guitar playing
Jashin J Wu MD
Dermatology Online Journal 15 (3): 16

Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California.


A 29-year-old man exhibited linear ridges of the right thumbnail that had been present for ten years. After he stopped playing the guitar for three months, the proximal portion of the abnormality cleared. Nail changes similar to the habit tic deformity may be produced by guitar playing.

Case report

A 29-year-old healthy Asian male presented with a ten-year history of linear ridges and depressions on the right thumbnail. He denied trauma to the nail or distal finger. The nail changes were asymptomatic. On further questioning, he did note that he played guitar recreationally and had started about ten years ago.

On physical examination, multiple 6 mm linear traverse ridges alternating with depressions were on the central aspect of the nail plate. There were no changes to the cuticle, nail folds, or the distal finger in general. All of the other fingernails and toenails were normal.

Figure 1
Figure 1. Several 6 mm linear traverse ridges alternating with depressions were seen on the central aspect of the nail plate of the right thumbnail.

The patient was instructed to stop playing the guitar for a few weeks to see if the nail changes would improve. On follow-up three months later, the proximal half of the right thumbnail was normal, and the distal half of the nail showed the same linear traverse ridges and depressions (Fig. 1). The patient stated that he had stopped playing the guitar, but he would probably start again in the future. He did not mind the cosmetic appearance of the nails if the changes returned.


Habit-tic deformity is a nail dystrophy caused by habitual external trauma to the nail matrix. It is characterized by a series of transverse ridges and depressions, most commonly on the thumbnail. Habit-tic deformity and median canaliform nail dystrophy, which resembles a fir tree on the thumbnail, have been thought to be related entities [1]. Habit-tic deformity has been successfully treated with multivitamins [2] and with fluoxetine [3] to address the psychological aspect of the disease process.

The trauma that causes habit-tic deformity is often believed to be of an external nature, such as picking at the cuticle. During guitar-playing by a right-handed individual, the right thumb is used to apply firm pressure to the largest string along the shaft of the guitar. Holding sustained pressure on this large-gauge metal string may cause strain onto the nail matrix on the opposite side of the thumb, creating the typical changes of the habit-tic deformity. Guitar and other string-based instruments should be considered as possible causes non-traumatic causes of the habit-tic deformity.


1. Griego RD, Orengo IF, Scher RK. Median nail dystrophy and habit tic deformity: are they different forms of the same disorder? Int J Dermatol 1995; 34:799-800. [PubMed]

2. Gloster H Jr, Kindred C. Habit-tic-like and median nail-like dystrophies treated with multivitamins. J Am Acad Dermatol 2005; 53:543-4. [PubMed]

3. Vittorio CC, Phillips KA. Treatment of habit-tic deformity with fluoxetine. Arch Dermatol 1997; 133:1203-4. [PubMed]

© 2009 Dermatology Online Journal