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Onychomycosis in the US Pediatric Population—An Emphasis on Fusarium Onychomycosis

Summary

This study examined nail fungus infections in American children using advanced molecular testing. Researchers found that elementary school-aged children (ages 6-11) have the highest rates of nail fungus, usually caused by common fungi like Trichophyton rubrum. Notably, Fusarium, an environmental fungus that was once rare in nail infections, is becoming increasingly common, especially in older teenagers, which may require different treatment approaches.

Background

Onychomycosis is a common nail disease with high recurrence rates and diagnostic challenges. While traditionally uncommon in children, understanding the etiologic profile in pediatric patients is important. This study aimed to update current knowledge of fungal pathogens causing onychomycosis in US pediatric populations using molecular diagnostics.

Objective

To characterize the etiologic profile of onychomycosis in pediatric patients using polymerase chain reaction (PCR) combined with histopathologic examination. The study focused on understanding the prevalence of dermatophytes, nondermatophyte molds (NDMs), and yeasts, with particular emphasis on emerging Fusarium species.

Results

An average of 37.0% of samples were mycologically confirmed as onychomycosis. Significantly higher positivity rates were found in 6-to-8-year-olds (47.2%) and 9-to-11-year-olds (42.7%). Dermatophytes accounted for 74.7% of cases, with Trichophyton rubrum complex being dominant. Fusarium was the most common NDM, showing age-dependent increase from 0.2% in youngest children to 3.3% in older adolescents.

Conclusion

Elementary school-aged children have higher onychomycosis rates, primarily due to Trichophyton rubrum infection. Fusarium species have emerged as significant nondermatophyte mold pathogens in pediatric onychomycosis, with increasing prevalence in older adolescents. Physicians should exercise caution with NDM detection and employ appropriate confirmatory testing methods for accurate diagnosis.
  • Published in:Pediatric Dermatology,
  • Study Type:Retrospective Cohort Study,
  • Source: PMID: 39425467, DOI: 10.1111/pde.15785
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