From the Guidelines
For onychomycosis in a 3-year-old child, the best approach is typically conservative management with topical antifungals rather than oral medications, but according to the British Association of Dermatologists' guidelines 1, systemic treatment with antifungals like terbinafine or itraconazole may be considered due to higher cure rates in pediatric populations. When considering treatment, it's essential to weigh the potential benefits and risks. The guidelines suggest that systemic antifungals can be effective in treating onychomycosis in children, with studies showing high clinical cure rates 1. Some key points to consider when treating onychomycosis in a 3-year-old child include:
- Gentle nail trimming and daily application of topical antifungals such as ciclopirox 8% nail lacquer or amorolfine 5% nail lacquer, applied to the affected nail(s) for 6-12 months 1
- Oral antifungals like terbinafine or itraconazole may be considered for severe cases under specialist supervision, with dosages recommended as follows: pulse itraconazole therapy (5 mg kg-1 per day for 1 week every month) for 2-3 months, or daily terbinafine at 625 mg per day if weight is < 20 kg, 125 mg per day for 20–40 kg weight, and 250 mg per day if weight exceeds 40 kg 1
- Good hygiene practices are essential, including keeping the child's feet clean and dry, using breathable footwear, and avoiding sharing towels or footwear with family members 1
- Treatment of onychomycosis in children requires patience as nail growth is slow, and complete resolution may take 6-12 months 1 It's crucial to note that the treatment approach should prioritize the child's safety and well-being, taking into account the potential risks and benefits of each treatment option. The British Association of Dermatologists' guidelines 1 provide a comprehensive approach to treating onychomycosis in pediatric populations, and should be consulted when making treatment decisions.
From the Research
Treatment Approaches for Onychomycosis in Children
Onychomycosis, or nail fungus, is a relatively uncommon condition in children, with a worldwide prevalence of approximately 0.3% 2. The most common cause of onychomycosis in children is Trichophyton rubrum.
Treatment Options
- Oral antifungal agents such as terbinafine, itraconazole, and fluconazole are effective in treating onychomycosis, but are not approved for use in children 2.
- Topical nail lacquers like ciclopirox and amorolfine may be used, but their efficacy in children is not well established 2.
- Newer topical antifungals with better nail penetration and delivery routes to the site of infection are being developed, and pediatric trials are ongoing 3.
Considerations for Treatment
- Treatment of onychomycosis in children can be challenging, and recurrence is more common in children than in adults 3.
- Prolonged systemic antifungal therapy is often required, but pediatric practitioners and parents may be hesitant due to potential systemic toxicities and the need for laboratory monitoring 3.
- Topical antifungal therapy may be a viable option for children due to their thinner and faster-growing nails, which may respond better to topical treatment than adult nails 3.
Importance of Diagnosis and Prevention
- Onychomycosis should be considered in the differential diagnosis of nail plate disorders in children, as it is a common cause of nail dystrophies 3.
- Confirming the clinical diagnosis of onychomycosis in children is crucial, and affected individuals should be examined for concomitant tinea pedis 3.
- Preventive measures, such as avoiding or promptly treating tinea pedis infections, can reduce the risk of recurrence 4.