Nail Disorders in Children

Erin L. Luxenberg; Robert A. Silverman


Dermatology Nursing. 2010;22(1) 

In This Article



Onychomycosis, or fungal infection of the nail, most often affects the toenails. Infected nails usually have a thick, yellow appearance and can become coarse and brittle (see Figure 4). When caused by dermatophytes, the infection is called tinea unguium. While there is a low prevalence of this disease in developed countries (0.2%-2.6%), there does appear to be an increased incidence in children with Down's syndrome or HIV (Baran, Hay, Tosti, & Haneke, 1998).

Figure 4.



The main techniques of diagnosis of fungal nail infection include potassium hydroxide smear, culture of the affected area, or histology of the nail scrapings (the most sensitive diagnostic approach) (Weinberg, Koestenblatt, Tutrone, Tishler, & Najarian, 2003).


Treatment of these fungal infections is difficult because the infection is embedded within the nail, and toenail growth is quite slow (about 0.3 mm/wk). Therefore, clinical cure may appear to take a year or longer. Most treatments are either systemic antifungal medications such as terbinafine (Goulden & Goodfield, 1995) and griseofulvin, or topical treatments such as nail lacquers that contain ciclopirox or amorolfine (Rodgers & Bassler, 2001).

Patient Education

The best way to prevent fungal infections is to keep the area dry and not walk around with bare feet. Children should be encouraged to dry the skin around nails after bathing and heavy sweating, and they should change their socks when they get wet.


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