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Anais Brasileiros de Dermatologia
On-line version ISSN 1806-4841
ARENAS, Roberto and RUIZ-ESMENJAUD, Julieta. Onychomycosis in childhood: a current perspective with emphasis on the review of treatment. An. Bras. Dermatol. [online]. 2004, vol.79, n.2, pp. 225-232. ISSN 1806-4841. http://dx.doi.org/10.1590/S0365-05962004000200011.
The prevalence of onychomycosis in childhood has been increasing, mainly caused by dermatophytes and also by Candida sp. These infections in children seem to be infrequent in the developed countries, while in Latin American they are not exceptional. Our main objective was to analyze the current medical literature. We have found dermatophyte onychomycosis in children as young as 2 years. The 12-16-year-old age group is reported as the most affected (66.4%), probably related to increased risk factors, such as sports and puberty/hormones. The source of infection was the parents in 46.2%, and 65% of relatives had onychomycosis or tinea pedis. Toenails are affected in dermatophyte infections and the most frequent variety is distal subungual onychomycosis (88.5%), but we also observed the white superficial form and the proximal white subungual form. Diagnosis is suspected on clinical examination, but mycological confirmation is necessary. The main dermatophyte agents are: T. rubrum (69%-92.7%), T. tonsurans (8.8%), T. mentagrophytes var interdigitale (5.4%) and M. canis (2.9%). Griseofulvin is the first line treatment, but itraconazole, fluconazole and terbinafine are also recommended for systemic treatment. Topical treatment with 8% cyclopirox, 5% amorolfine and 40% urea plus 1% bifonazole may be a therapeutic alternative. Since few reports are available regarding onychomycosis in children, we were not able to conclude which is the best therapeutic approach. More clinical data are needed to establish the safety profile of the new antimycotic drugs to determine the optimal management of onychomycosis in childhood.
Keywords : child; onychomycosis.