Nail Disorders in Children

Abstract

Nail diseases in children do not account for a significant proportion of pediatric consultations, and most of the time the nails are not observed by the clinician, overlooking their importance. Specific examination of the nails is neglected, while localization to the nails could be an initial sign of a syndrome or a systemic disorder. Nail diseases in the pediatric population differ from those in adults in terms of diagnostic approach and management; some of them even are manifested mainly or exclusively in children. Pediatric patients with underlying systemic disorders are more likely to manifest acquired disorders of the nails. Although rare, nail diseases in children are a source of anxiety for the parents. Examination of the nails is an essential part of pediatric physical examination. A correct clinical history and careful examination help the clinician to distinguish the different conditions and to decide on the correct management of nail diseases in young patients. A classification of nail dystrophies according to age is somewhat arbitrary and a unique classification does not exist. Nail diseases in the pediatric population can be divided according to age groups where a predilection appears in most of the cases. Moreover, certain abnormalities may be lifelong once acquired, but their presentation may be modified by age, worsening or improving during life. This review describes many of the nail conditions that are seen in the pediatric population aging from newborn to toddler, starting with physiological aspects to better recognize the pathological conditions.

Frequency of Nail Abnormalities in Children and Adolescents Admitted to a Dermatology Outpatient Clinic

“…The spectrum of nail abnormalities in childhood and adolescence exhibits some differences from adults. Physiological changes, congenital and hereditary nail abnormalities, bacterial and viral diseases affecting nails are more common in this age group, while fungal infections of nails are less common than adults (7). In our study, the most common nail abnormality was leukonychia.…”

“…In the current study, three infants were diagnosed as congenital malalignment of the great toenails. It is an isolated nail abnormality and described as lateral deviation of the great toenail axis relative to the axis of the distal phalanx (7). It can cause ingrown nail or onychogryphosis.…”

Koilonychia secondary to Raynaud's phenomenon: A rare co-occurrence

“… 2 Early childhood koilonychias are often secondary to tight-fitting shoes or finger sucking, both of which resolve with behavior modification. 2 , 8 Hereditary cases of the disease also occur in an autosomal dominant pattern. Rarely, koilonychia has been observed in patients with systemic lupus erythematous and Raynaud's phenomenon, typically involving abnormal proximal nail fold capillary loops, splinter hemorrhages, and red lunulae—signs that were not present in our case.…”

Absent fingernails and missing finger skin folds in a 16‐month‐old boy

“…The differential diagnosis for congenital hypoplastic or dysplastic fingernails/toenails includes syndromic causes (such as ectodermal dysplasias, Coffin‐Siris syndrome, and congenital onychodysplasia of the index fingers/Iso‐Kukuchi syndrome), isolated anonychia/hyponychia congenita (secondary to autosomal recessive RSPO4 mutations), intrauterine medication exposure (ie, phenytoin, warfarin, and alcohol), and physiologic nail variants. Individuals with an ectodermal dysplasia (ED), including hypohidrotic ED, may have a variety non‐specific nail changes including anonychia, micronychia, hypoplasia, or onycholysis 6 . Triangularly shaped toenails and absent fingernail lunulae are physiologic nail variants present in up to 50% of newborns 7 ; these features typically resolve with time.…”

“…Individuals with an ectodermal dysplasia (ED), including hypohidrotic ED, may have a variety non-specific nail changes including anonychia, micronychia, hypoplasia, or onycholysis. 6 Triangularly shaped toenails and absent fingernail lunulae are physiologic nail variants present in up to 50% of newborns 7 ; these features typically resolve with time.…”