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Presentation

Pediatric Onychomycosis: Recent Advances and Treatment Approaches

Description

Julie Morwick from the University of Michigan discusses pediatric onychomycosis, noting its increasing prevalence with age, with a culture-positive rate of about 0.33% in children. Commonly, the condition is caused by dermatophytes, particularly Trichophyton rubrum, although non-dermatophyte molds like Fusarium are becoming more prevalent, complicating treatment options. Morwick emphasizes the importance of accurate diagnosis before antifungal treatments and highlights that only about 15% of nail dystrophies in children are actually due to onychomycosis. Special populations, such as children with Down syndrome, are at higher risk, necessitating consideration of immunosuppression. She shares insights on neonatal-acquired candidiasis, which generally resolves without intervention and responds well to topical treatments. For treating onychomycosis, topical therapies are generally more effective in children than in adults due to factors like thinner nails and shorter infection duration. Efinaconazole is noted as an effective option, while oral therapies seem to yield higher cure rates. Morwick cautions against using griseofulvin due to poor efficacy and discusses the easier risk management associated with oral terbinophen, suggesting baseline lab tests but not routine monitoring due to low incidence of side effects. Overall, she underscores the need for tailored approaches based on accurate diagnostics and individual patient profiles.

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Conclusions

The prevalence of pediatric onychomycosis increases with age, with a reported average of 0.33% in children.
Commonly, pediatric onychomycosis presents as distal lateral subungual onychomycosis, primarily caused by Trichophyton rubrum.
Fusarium is emerging as a significant non-dermatophyte mold in pediatric onychomycosis cases.
Down syndrome is a risk factor for onychomycosis, necessitating consideration of potential immunosuppression in severe cases.
Accurate diagnosis is crucial, as approximately 15% of nail dystrophies in children may be misdiagnosed as onychomycosis.
Neonatal acquired candidiasis can result in onychomycosis, typically improving without treatment as nails grow out.
Topical therapies are generally more effective in children due to thinner nail plates and faster nail growth compared to adults.
Efinaconazole appears to be an effective topical treatment option for pediatric onychomycosis, with success rates around 65%.
Systemic antifungal treatments, especially terbinafine and itraconazole, have higher cure rates but are off-label for children, necessitating careful monitoring.
Routine laboratory monitoring during terbinafine treatment may be unnecessary due to the low incidence of hepatotoxicity in children.

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