Please help with fungal nail of 2 year old

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Hello everyone,

I would appreciate some advice please regarding a 2 year old's toenails.

The child as born with talipes and has had multiple surgeries. He is now wearing the Dennis-Browne bar (his feet are enclosed in boots all the time, including overnight to sleep).

His Mother would like advice on how to treat the toenails.

She has tried applying vinegar daily for a few months with no improvement so far.

Thanks in advance

Gen

 

Hi Gen,

It is very unusual for a two-year old to develop OM, so I would first obtain a definitive diagnosis - via microscopy and culture to identify which (if any) pathogens are at play - as the discolouration is more likely to be due to trauma. Application of vinegar should be discouraged as acetic acid is cytotoxic to both keratinocytes and fibroblasts, so will delay any healing to the tissues.

Cheers,
Bel

 

Hi Bel,

Thanks very much for your response.

Would you have a preference for treatment once OM was confirmed?

Regards

Gen

 

Hi Gen,
Hi agree with everything Blinda said.
I would consider applying clotrimazole cream 1 -2x day.
I would not suggest this for an adult.

 

It depends on where you are based, Gen. If you are in the UK, then unless you have IP you cannot supply any antifungal (other than griseofulvin, which is a bit pants TBH, as efficacy is not as great as the azoles or terbinafine) to patients under 12 years old as they are not licensed for kids. They will have to obtain a prescription from their GP if the M&C proves positive for tinea.

 

Thanks Mark and Belinda.
I know it is unusual, given his young and hence the reason for the post.
I am in Australia so similar story in terms of prescription rights
I appreciate you taking the time to respond and thanks for the advice
Gen