Onychomycosis and Children – A Multicenter Study

Abstract

Summary Onychomycosis is a chronic disease caused by dermatophytes, yeasts and molds, which leads to destruction of the nail plate of the fingernails and toenails. The incidence of onychomycosis in children is considerably smaller compared with that in adults. Onychomycosis in children under 6 years of age is particularly unusual. The trauma and the hyperhidrosis after puberty are the major predisposing factor for fungal nail infection in childhood. Some systemic diseases and congenital syndromes have a crucial role for the development of onychomycosis in children. Wearing infected socks and shoes of other family members, family history for fungal infection of the nails, reduced hygiene and onychophagia are other important predisposing factors. Dermatophytic species Trichophyton rubrum, Trichophyton mentagrophytes and Epidermophyton flocosum are the most frequent causative agents of onychomycosis in adults and much less common yeast of the genus Candida. A retrospective study for a period of 11 years was performed (2003-2013) investigating 292 children aged 0 to 18 years with proven onychomycosis (123 - from Plovdiv, Bulgaria, 94 - from Pleven, Bulgaria, and 75 - from Thessaloniki, Greece). Candida albicans was the main etiologic agent in onychomycosis in children under 18 years of age, according to the performed retrospective study. The diagnose was made by direct microscopic examination and fungal culture on Sabouraud agar media.

Analysis of superficial mycoses in children examined in 2013–2016 in the Unit of Medical Mycology at the Department of Dermatology, Poznan University of Medical Sciences

“…Distal and lateral subplate onychomycoses are the most common [1,18,19]. Gradual hyponychium keratosis leading to onycholysis takes place [9].…”

“…According to the literature, Candida is the most common cause of onychomycosis in children 3-12 years of age [18] The average age of patients with nail candidiasis in the study group of children was 11 years. The youngest child was 4 years old, and the oldest was 17 years old.…”

“…Fungal nail infection in children is rare, which is probably due to the faster growth of the nail plate and its smaller area [3]. The mold flora represents 3% of all nail pathogenic fungi [18].…”

“…Rare cases of Scedosporium apiospermum ci w porównaniu z dorosłymi, który ma związek z lepszym ukrwieniem [17]. Najpowszechniejsza jest postać dystalna i boczna podpłytkowa grzybicy paznokci [1,18,19]. Stopniowo następuje rogowacenie obrąbków naskórkowych paznokcia, co powoduje oddzielanie się paznokcia od łożyska (onycholizę) [9].…”

“…Według piśmiennictwa najczęstszą przyczyną tej choroby u dzieci w wieku 3-12 lat jest Candida [18]. Średni wiek pacjentów z kandydozą paznokci wynosił 11 lat.…”