Differential Diagnosis for Nails of Child Sloughing Off
Single Most Likely Diagnosis
- Onychomadesis: This condition is characterized by the sloughing off of nails, often due to a temporary interruption in nail growth. It can be caused by systemic illnesses, infections, or trauma. In children, it might follow a febrile illness, making it a common and likely diagnosis.
Other Likely Diagnoses
- Alopecia Areata: While primarily known for causing hair loss, alopecia areata can also affect the nails, leading to brittleness, ridging, and potentially nail loss. Its autoimmune nature means it can present in various ways, including nail sloughing.
- Psoriasis: Nail psoriasis can cause a variety of changes, including pitting, thickening, and separation of the nail from the nail bed, which might eventually lead to sloughing off. Given the prevalence of psoriasis and its potential to affect nails, it's a plausible diagnosis.
- Fungal Infections: Fungal infections of the nail (onychomycosis) can cause thickening, brittleness, and eventual loss of the nail. Though more common in adults, children can also be affected, especially if they have exposure to fungal spores or compromised nail health.
Do Not Miss Diagnoses
- Kawasaki Disease: This acute febrile illness can cause desquamation of the skin, including the fingertips, which might lead to nail sloughing. Given its potential for serious cardiac complications, it's crucial not to miss this diagnosis.
- SLE (Systemic Lupus Erythematosus): SLE can cause a wide range of symptoms, including skin and nail changes. Nail sloughing could be part of a broader presentation of this autoimmune disease, which requires prompt diagnosis and treatment to prevent serious complications.
Rare Diagnoses
- Epidermolysis Bullosa: A group of genetic conditions that result in blistering of the skin and mucous membranes. Some forms can affect the nails, leading to their loss. While rare, the severity of these conditions warrants consideration in cases of unexplained nail sloughing.
- Lichen Planus: An autoimmune condition that can affect the skin, mouth, and other areas, including the nails. Nail involvement can lead to thinning, ridging, and potential loss. It's less common in children but should be considered in the differential diagnosis due to its potential for significant morbidity.