Trachyonychia is not a distinctive disease but only the clinical result of disorders that involve the nail matrix. Clinically, it can be divided into two main groups: idiopathic TND and TND associated with other dermatological diseases including alopecia areata, lichen planus, eczema, and psoriasis. Its incidence in the pediatric population is unknown. It can be present at any age, but the mean age at appearance is 2.7 years (range 2–7). This is a benign inflammatory nail condition of the proximal nail matrix. Trachyonychia, or twenty-nail dystrophy (TND), means nail roughness. This review describes many of the nail conditions that are seen in the pediatric population aging from newborn to toddler, starting with physiological aspects to better recognize the pathological conditions. Moreover, certain abnormalities may be lifelong once acquired, but their presentation may be modified by age, worsening or improving during life. Nail diseases in the pediatric population can be divided according to age groups where a predilection appears in most of the cases. A classification of nail dystrophies according to age is somewhat arbitrary and a unique classification does not exist. A correct clinical history and careful examination help the clinician to distinguish the different conditions and to decide on the correct management of nail diseases in young patients. Examination of the nails is an essential part of pediatric physical examination. Although rare, nail diseases in children are a source of anxiety for the parents. Pediatric patients with underlying systemic disorders are more likely to manifest acquired disorders of the nails. Nail diseases in the pediatric population differ from those in adults in terms of diagnostic approach and management some of them even are manifested mainly or exclusively in children. Specific examination of the nails is neglected, while localization to the nails could be an initial sign of a syndrome or a systemic disorder. This ensures the toe itself is what is hitting the shoe, and not the nail.Nail diseases in children do not account for a significant proportion of pediatric consultations, and most of the time the nails are not observed by the clinician, overlooking their importance. Keeping the nails moisturized with either vitamin E oil, tea tree oil, a urea based cream or nail gel, or other moisturizers may be of benefit.Īs a general rule, it is always advised to keep the nail cut shorter than the end of the toe. In these cases, little can be done to improve the rate of growth of the toenails. Other times, when the nails don’t seem to grow, it could be from nutrition, other systemic diseases, injury to the root of the nail, or other factors. Many times, the old toenail will need to be removed to prevent the area below the nail from staying constantly moist, which could predispose to infection. It takes 4-6 months for the new toenail to grow out to the end of the toenail. Often times, the fluid, or blister under the toenail will drain, but this nail stops growing. When this occurs, the nail is separated from the root of the nail, resulting in a new toenail growing below the existing toenail. Whether a day or two of hiking, playing soccer, wearing tight fitting, closed toe dress shoes at a wedding, or simply from walking in a pair of shoes too tight, constant pressure on the toenail can result in fluid accumulation below the nail. While the causes of an absence of nail growth can vary widely, many of these cases are the result of some sort of repetitive trauma to the nail. Periodically we see patients who have varying histories, yet a commonality of one or more of their toenails no longer growing, often for a duration of 4 or more months.
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