Paediatrics: Nail disorders

Nail disorders

Paronychia

Acute paronychia

Common, particularly in newborns. It presents as acute inflammation and tenderness of nail folds and surrounding skin.

Treatment     

Topical    antiseptics,       and,       if       severe,        oral   antibiotic,   e.g.

cephalexin.

Chronic paronychia

Associated with nail dystrophy. It is usually caused by chronic wetness (e.g. thumb sucking, resulting in infection with mixed bacteria and Candida).

Treatment 

Keep nail dry; topical nystatin and antiseptics.

Tinea unguium (onychomycosis)

Nail biting

Common habit. Permanent nail damage may occur if nail matrix dam-aged.

Treatment 

Gentle dissuasion! Proprietary topical nail solutions that impart a very unpleasant taste may be effective.

Ingrowing toe-nails

Most commonly involves the hallux. A spicule of nail grows into lateral nail fold leading to pain, bacterial paronychia, and granulation tissue.

Treatment

•   Local antiseptic.

•   Careful trimming of nail spicule.

•   Education on correct toe-nail cutting.

•   Silver nitrate cauterization of granulation tissue or radical surgery is required when severe.

Subungual haemorrhage

Caused by trauma leading to haemorrhage under nail. Perforation of nail with hot needle is curative and relieves pain immediately.

Nail abnormalities secondary to generalized disease

• Congenital abnormal nails (usually atrophic) may be due to rare inherited conditions, e.g. ectodermal dysplasia.

• Clubbing: s to chronic pulmonary suppuration, e.g. cystic fibrosis, fibrosing alveolitis, bacterial endocarditis, cyanotic congenital heart disease, malabsorptive states, IBD, hepatic cirrhosis.

• Onycholysis: premature separation of nail from nail bed due to psoriasis, trauma, eczema.

• Koilonychia: spoon-shaped nails due to chronic iron deficiency anaemia. (Koilonychia is normal in the first few months of life.)

• Nail pitting: occurs in psoriasis, eczema, alopecia areata.

• Beau’s line: transverse groove in nail caused by severe systemic illness.

• Splinter haemorrhages: due to bacterial endocarditis, trauma.

• Yellow nail syndrome: due to defective lymphatic drainage (also affects the lungs).

Nail–patella syndrome: rare autosomal dominant condition with small rudimentary patella, elbow deformities, reduced or longitudinal split nails. Rarely, chronic glomerulonephritis develops.