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In addition to TTM, promising preliminary results suggest the need for controlled studies in other grooming disorders, including nail biting and skin picking.39,41 A case report was published regarding an individual with both TTM and nail biting behaviours, in whom nail biting ceased following 9 weeks of NAC treatment.39 The participant relapsed after a hiatus in treatment, but recommencement of NAC resulted in a remission of symptoms.39 A serendipitous finding of the benefit of NAC treatment in the reduction of nail biting in a study primarily investigating NAC (2000 mg/d) in the treatment of mood disorders has been reported.41 Three participants taking NAC reported significant reductions in nail biting during the 6-month course of treatment

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Additionally, symptoms may reappear without changes in biomarker status