Nail Disorders in Children

Erin L. Luxenberg; Robert A. Silverman


Dermatology Nursing. 2010;22(1) 

In This Article

Parakeratosis Pustulosa


Parakeratosis pustulosa (PP) is a cause of distal nail inflammation and nail dystrophy that affects a single digit. It is nonpruritic and minimally painful. This distal digital dactylitis is characterized by the lack of a cuticle along with erythematous swelling of the proximal and lateral nail folds. The distal free edge of the nail demonstrates hyperkeratosis while eczema of the nail bed causes onychomadesis (see Figure 5).

Figure 5.

Parakeratosis pustulosa


PP is diagnosed clinically, and most often affects girls under 5 years of age. Onychomadesis, ragged and absent cuticles, subungual hyperkeratosis, and characteristic bright red adjacent skin with a well-demarcated border aid in pinpointing the diagnosis. This diagnosis should be made in the absence of psoriasis, atopic dermatitis, or other skin diseases (Hjorth & Thomsen, 1967).


There is no specific treatment for PP. Most cases will improve gradually, though some clinicians advocate treating with highpotency topical steroids in combination with topical clotrimazole solution. Lesions can last from 1 week to several years; recurrences are rare.

Patient Education

Observation and followup of patients can continue for over a decade (Pandhi, Chowdhry, Grover, & Reddy, 2003).


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