Onychomycosis in Children: 3 Alternative Conditions Possibly Disguised as Toenail Fungus

Pediatricians, dermatologists and podiatrists are often alarmed at the number of children who arrive at their practices having been subjected to oral antifungal drugs and topical treatments for nail fungus, when it turns out they did not have nail fungus at all. Self-diagnosis mat not only be costly, but it exposes patients to a lot of unnecessary side effects and does not treat the real problem. According to Dr. Robert A. Silverman, a pediatric dermatologist at Georgetown University Medical Center in Washington, there are three conditions often mistaken for toenail fungus.

child foot infections

The SteriShoe UV shoe sanitizer is a device that helps protect kids from toenail fungus recurrence and other foot infections.
Image Source: Flickr user Nina Matthews Photography

How Common Is Toenail Fungus in Children?

It is estimated that less than 3% of children in developed countries contract toenail fungus. “At-risk” populations include youngsters who have HIV, Down syndrome, or family members who have been exposed to the Trichophyton rubrum dermatophyte.

What Are the Signs of Toenail Fungus?

With toenail fungus, the nails thicken and turn yellow with crumbling edges. However, severe nail fungus may cause the nail to turn black and fall off, and mild nail fungus may just look like small, dry white patches on the surface of the nail plate. The fungus generally does not cause itching, sensitivity, or pain. Sometimes patients suffer from athlete’s foot and toenail fungus at the same time.

nail disorder

It can be difficult to tell what exactly is ailing the nails.
Image Source: IrishHealth.com

What Other Conditions Are Mistaken for Toenail Fungus?

Not so fast! Your child’s nail may not be infected with a fungus. Instead, it could be:

Psoriasis: The defining signs of psoriasis are the large, irregular pits, thickening and separation of the nail bed, a red-orange “oil drop” under the nail, and white spots on the nail plate. In the most severe cases, the nail may crumble like with a fungal infection. Sometimes a nail biopsy is the only way to tell the difference between psoriasis and nail fungus.

– Subungual tumors: These benign growths on the bone are most often found in children. Signs may include nail bed separation, red-blue-purple lesions under the nail, pain, cold sensitivity, and tenderness.

– Alopecia areata: Roughly 4.5 million Americans suffer from this type of hair loss where the immune system attacks the hair follicles. Sometimes the nails become pitted and lose their luster before other symptoms (like hair loss) occur.

How Is Nail Fungus Diagnosed & Treated?

A doctor can scrape the nail and examine the cells under a microscope to know for sure if it is fungus or not. It is important to obtain a culture first because the duration of treatment covers several months. Most often, toenail fungus treatment involves prescribing the oral antifungal terbinafine for six to 12 weeks, even though it’s technically considered an “off-label use” in children. Griseofulvin is well tolerated and sometimes used, but the course of treatment could take up to a year. In very mild cases, a topical nail lacquer may be used.

rain boots

Sanitizing the shoes is part of an effective treatment for toenail fungus.
Image Source: Flickr user audreyjm529

How Can Parents Protect Children from Recurrent Fungus?

Toenail fungus is one of those conditions that tends to recur multiple times. Since fungus reproduces by way of tiny spores, they can be easy to miss — and, therefore, continue to re-infect the feet. Items like socks, sheets, towels, and shoes must be thoroughly cleansed and sanitized. Since footwear can be difficult to clean adequately, we recommend using the podiatrist-recommended, FDA-approved SteriShoe UV shoe sanitizer, a device that uses germicidal ultraviolet light to kill the bacteria, fungi, viruses, and other microbes living in the shoes in just 45 minutes. Buy one for your family here!

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