What Is the Diagnosis? Onycho-Trichotillomania: An Unusual Case Report

Nail discoloration is commonly attributed to fungal or bacterial infections, trauma, or inflammatory nail disorders. In rarer cases, however, chromatic alterations may result from compulsive or repetitive behaviors—subtle signs often overlooked during the initial assessment. This case highlights the importance of a comprehensive diagnostic approach: clinical examination and laboratory testing ruled out typical causes, whereas dermoscopy and microscopic analysis, combined with detailed behavioral evaluation, uncovered an unexpected psychodermatologic etiology. The case underscores the need for diagnostic openness and sensitivity to behavioral cues, reminding clinicians that careful observation can reveal hidden causes behind seemingly common dermatologic presentations.