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In the nail bed, hyperpigmentation may also be present.43 These habits predispose to complications such as paronychia, transmission of viral warts, and dental alterations including malposition and fractures, as well as oral infections.43 The differential diagnosis includes onychomycosis, psoriasis, lichen planus, chronic paronychia, and nail-patella syndrome, among others.44 Treatment of OCD can be challenging and should include a multidisciplinary approach

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Moreover, progesterone enhances the release of gonadotropin-releasing hormone (GnRH) and increases the sensitivity of the pituitary gland to GnRH, thereby triggering an LH surge