### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
I BITE MY KNUCKLES, I ALSO PULL THE HAIRS OUT OF THEM WITH MY TEETH. THEN WHEN I CANT GET TO THE HAIR BECAUSE ITS STILL UNDER MY SKIN. I PEEL MY SKIN BACK AND THEN PULL THE HAIR OUT. THEN MY KNUCKLES MAY START BLEEDING. ITS LEFT ALL MY FINGERS SCARRED AND NOW MY KNUCKLES LOOK WIERD, SO I TRY NOT TO SHOW MY KNUCKLES.IVE BEEN DOING THIS For About 4 years. DO you Know ANy treatments or things i can do to get rid of the scars? please. id appreciate it - Leilah

### output:

Hello I have read your query and can understand your concern. You have habit of biting your knuckles and also habit of pulling the hairs out of them. The habit is so persistent that knuckles start bleeding. These symptoms are present since last 4 years. Most likely the symptoms are part of disorder called as trichotillomania. This is an impulse control disorder of psychiatry in which intense urge occur to pluck or pull hair followed by plucking the hair. It causes significant distress to individual, and it also causes cosmetic impairment. Underlying anxiety is one of main reason behind such symptoms. I would advise you to consult a good Psychiatrist for expert opinion. Many good antianxiety Chat Doctor.  Fluoxetine when used for about 4-6 weeks result in improvement in this disorder. Consult a Psychiatrist for expert opinion on this problem. Apart from that Behavior therapy is also very useful in decreasing the undesired behavior. Hope this helps you. Thanks