From the Guidelines
The most common nail changes in pediatric patients with diabetes include onychomycosis, paronychia, and splinter hemorrhages, with onychomycosis being a significant predictor for the development of foot ulcers in diabetes, as noted in the British Association of Dermatologists' guidelines for the management of onychomycosis 2014 1.
Key Nail Changes
- Onychomycosis (fungal nail infections): This condition is prevalent in diabetics due to impaired glycaemic index, ischaemia, neuropathy, and local immunosuppression, making terbinafine the preferred oral antifungal agent for treatment due to its low risk of drug interactions and hypoglycaemia 1.
- Paronychia (infection of the skin around the nails): Often resulting from minor trauma combined with high glucose levels that promote bacterial growth.
- Splinter hemorrhages: Appearing as thin, reddish-brown lines in the nail bed, which may indicate microangiopathy.
Importance of Nail Care
Regular inspection of a child's nails during diabetes management is crucial as nail changes can serve as early indicators of complications or poor glycemic control. Proper nail hygiene, including keeping nails trimmed and dry, is essential for prevention. The most recent guidelines on foot care in diabetes, such as those from Diabetes Care in 2021 1, emphasize the importance of patient education on proper foot and nail care to prevent complications.
Prevention and Treatment
- Daily foot inspection, including nail and skin care, is recommended for patients with diabetes, especially those at high risk 1.
- Proper footwear and footwear behaviors should be discussed, and patients should be advised against walking barefoot or in socks only, whether at home or outside 1.
- Treatment of any pre-ulcerative sign on the foot, including removing callus, protecting blisters, and treating ingrown or thickened toenails, is necessary to prevent foot ulcers 1.
From the Research
Nail Changes in Pediatric Patients with Diabetes
The most common nail changes in pediatric patients with diabetes are not explicitly stated in the provided studies, as they primarily focus on adult populations. However, we can infer some information from the available data:
- Onychomycosis, a fungal infection of the nail, is a common issue in diabetic patients, and its prevalence increases with age 2, 3, 4, 5, 6.
- Nonfungal onychodystrophy (OD) is also alleged to be frequent in diabetic patients, with nail changes such as subungual hyperkeratosis, onycholysis, yellow discoloration, and splinter hemorrhages being observed in more than 25% of patients 2.
- Factors associated with the presence and severity of toenail onychomycosis in patients with diabetes include poor foot hygiene, high hemoglobin A(1)c levels, and a lower toe brachial index 4.
- Fungal infections, including onychomycosis and tinea pedis, are more prevalent in diabetic patients and can contribute to the severity of diabetic foot complications 5, 6.
Common Nail Changes
Some common nail changes observed in diabetic patients include:
- Subungual hyperkeratosis
- Onycholysis
- Yellow discoloration
- Splinter hemorrhages
- Onychomycosis (fungal infection of the nail)
- Tinea pedis (fungal infection of the foot)
Key Findings
- Diabetic patients are at a higher risk of developing fungal infections, including onychomycosis, due to impaired sensation and circulation 5.
- Early detection and treatment of fungal infections are crucial to prevent complications, such as diabetic foot ulcers 4, 6.
- Good foot hygiene and control of blood glucose levels can help prevent fungal infections and nail changes in diabetic patients 4.