Nail Disorders in Children

Erin L. Luxenberg; Robert A. Silverman


Dermatology Nursing. 2010;22(1) 

In This Article

Periungual Warts


Located in the longitudinal grooves of the proximal nail folds, periungual warts are often a source of embarrassment, deformity, and pain. When located in the lateral nail folds, they can cause fissures and discomfort. When they originate from the hyponychium they can cause nail elevation and onychauxis (abnormal overgrowth and/or thickening of the nail) (see Figure 6) (Tosti & Piraccini, 2001).

Figure 6.

Periungual warts


Most often caused by HPV 1, 2, or 4, periungual warts are diagnosed via clinical appearance. These verrucous lesions are characterized by cauliflower-like thickened skin. The absence of skin lines crossing the surface is a cardinal sign of all warts, as is the presence of pinpoint black marks, representing subkeratotic capillary thromboses (Tosti & Piraccini, 2001).


There are a host of treatments for periungual warts that include duct tape, immunomodulators such as imiquimod or 5-fluorouracil cream, laser ablation, and surgical excision. Keratolytics such as salicylic acid in concentrations up to 70% or cantheridin appear to be the best first-line approach, especially in children. Cryotherapy with liquid nitrogen is a second-line treatment for periungual warts in young children because proper application is quite painful and usually requires repeated treatments. Nevertheless, definitive treatment is not a guarantee with any approach, and periungual warts often recur (Tosti & Piraccini, 2001).

Patient Education

The risk of developing periungual warts is increased by trauma to the area. It is therefore advised that patients avoid nail biting and cuticle picking. Over-the-counter cryogenic sprays are not cold enough to be useful for treating warts in this location. Sprays that contain dimethyl ether may cause chemical burns of surrounding tissues if there is prolonged exposure by overzealous application.


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