Ava Monroe
There are many reasons why a toddler's fingernails might fall off. The clinical term for nails peeling off from the proximal nail folds is onychomadesis, which can occur after viral infections, such as hand-foot-mouth disease, or after injury or trauma to the nail area. In some cases, onychomadesis may be a symptom of an underlying condition, such as psoriasis, hyperthyroidism, or type 1 diabetes. Treatment for onychomadesis focuses on new nail growth and keeping the nail attached to the underlying nail bed.
| Characteristics | Values |
|---|---|
| Clinical term | Onychomadesis |
| Cause | Viral infections, such as HFMD, chickenpox, or strains of coxsackievirus |
| Treatment | No specific work-up or treatment is necessary; nails will improve over several months without lasting effects |
| Recovery time | Fingernails may take 4 to 6 months to grow back, while toenails may take 12 to 18 months |
| Prevention | Avoid irritants, keep nails short and trimmed, minimize activities that can result in nail injury |
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What You'll Learn
Viral infections like HFMD, chickenpox, and coxsackievirus
Fingernail and toenail loss in toddlers can be caused by viral infections like hand-foot-mouth disease (HFMD), chickenpox, and coxsackievirus. This condition is called onychomadesis, where nails peel off from the proximal nail folds. It is often observed in the nails of the middle finger, followed by the thumb and ring finger. HFMD is a common viral infection affecting children younger than 10 years, and it has been linked to onychomadesis. Osterback et al. suggested that virus replication could damage the nail matrix, leading to nail shedding. Additionally, studies have shown that inflammation secondary to viral infection around the nail matrix might be induced directly by the virus.
Chickenpox has also been associated with onychomadesis. In one case, a 7-year-old girl who had recovered from chickenpox presented with onychomadesis of the right index fingernail, with all other nails appearing normal. This suggests that viral infections can have varying effects on different individuals.
Coxsackievirus is another viral infection that has been associated with onychomadesis in toddlers. It is one of the causes of hand-foot-mouth disease, which can lead to nail shedding.
It is important to note that in most cases of viral infections, no specific work-up or treatment is necessary. Nails will usually improve and return to normal within a few months without any lasting effects. However, it is always recommended to consult a healthcare professional for proper diagnosis and treatment if your toddler experiences nail loss.
Furthermore, taking good care of your toddler's wound is crucial to promote healing and reduce the risk of infection. The wound typically heals within a few weeks, but fingernails may take up to 6 months to grow back completely, while toenails can take 12 to 18 months. Injured nails may also look different when they regrow. Therefore, follow-up care is essential for your child's treatment and safety.
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Inflammatory conditions like lichen planus
Lichen planus affects men and women equally and is characterized by small, reddish-purple, flat-topped bumps. It tends to clear up within a couple of years in most people, and the bumps usually fade with time without treatment. However, in some cases, it may result in nail loss. Nail changes associated with lichen planus include longitudinal ridging and grooving, splitting, thinning, and nail loss. In severe cases, pterygium may develop, and the nail may be temporarily or permanently destroyed.
There is no known cure for lichen planus, but treatment can help control the lesions and relieve itching. Treatment options include topical steroids and oral medications such as steroids or phototherapy (light box therapy) for more severe cases. Prompt systemic and intramatricial steroid treatment is required to avoid potential scarring of the nail matrix and permanent damage. Identifying and discontinuing the use of certain medications that may be causing an allergic reaction can also help clear up the condition within a few weeks.
Other possible causes of your toddler's fingernail falling off include viral infections such as hand, foot, and mouth disease (HFMD) and varicella infection (chickenpox), frequent hand washing, Candida infection, and allergic contact dermatitis. It is important to consult a healthcare professional to determine the exact cause and receive appropriate treatment.
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Injury or trauma to the nail area
Losing a toenail or fingernail due to an injury is called avulsion. This can happen when there is trauma to the nail area, causing the nail to be completely or partially torn off. In the case of toddlers, this could be due to physiological alterations during birth or the result of simple traumata that induce inflammation of the nail matrix. This inflammation can lead to conditions such as leukonychia, where a milky white discoloration occurs within the nail plate due to the presence of foci of parakeratotic cells. Leukonychia can be punctate or transverse, with the former being more common in toddlers as it is typically restricted to the first toenails.
Another possible explanation for nail loss in toddlers is a condition called Beau's lines, which are transverse nail plate surface depressions resulting from mild trauma to the proximal nail matrix. Beau's lines can cause reduced nail growth and are often associated with ectodermal dysplasias, a group of congenital disorders that affect the development of ectodermal structures such as hair, nails, teeth, and sweat glands.
In the event of nail avulsion, it is important to seek medical attention for your toddler. The doctor may remove the nail, put part of it back into place, or repair the nail bed. Follow-up care is crucial to ensure proper healing and prevent infection. The wound should heal within a few weeks, but it is important to keep the area clean and follow the doctor's instructions for wound care.
Additionally, it is worth noting that injured nails may look different when they grow back, and fingernails may take up to 6 months to regrow, while toenails can take 12 to 18 months. If you notice any unusual symptoms or changes in your toddler's nail after the injury, be sure to consult a healthcare professional for further advice and treatment.
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Fungal infections and skin conditions like psoriasis
It is important to know the difference between nail psoriasis and a fungal infection, as they have different causes, symptoms, risk factors, and treatments. Both conditions can cause nail pitting, thickening, or structural changes. However, they also have distinct characteristics.
Nail psoriasis is an autoimmune disease that causes skin cell overproduction, leading to skin scaling and discoloration. It can also affect the nails and nail beds, causing the nails to detach from their beds and potentially fall off entirely or break off in pieces. This is more common with nail psoriasis than with a fungal infection. Before the nail falls off, a gap usually develops between the nail and the fingertip, and white, chalky buildup may be observed under the nail. This overgrowth of keratin under the nail is called subungual hyperkeratosis.
Fungal nail infections, on the other hand, are contagious and caused by fungi that flourish in warm, moist environments, such as showers and swimming pools. They attach to a specific portion of the nail and spread as the nail grows. Fungal infections tend to change the shape and appearance of the nails, causing discoloration, cracking, or nail separation from the nail bed. They can cause nail darkening and a foul odor, and while nail loss is rare, it can occur.
It is worth noting that having psoriasis may make individuals more vulnerable to fungal nail infections, and it is possible to have both conditions simultaneously. Therefore, it is crucial to consult a doctor to obtain an accurate diagnosis and appropriate treatment.
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Allergic contact dermatitis
- Nickel, often related to piercings, buttons, fasteners, clips, toys, jewellery, and footwear.
- Myroxylon pereirae (Balsam of Peru), found in some fragranced products.
- Preservatives such as methylisothiazolinone and other isothiazolinones, particularly due to the use of baby wipes.
- Fragrance mixes relating to the use of fragranced products.
- Colophonium found in adhesive tapes and musical instruments.
Other common causes of contact dermatitis in toddlers include:
- Poison ivy, oak, and sumac. These are plants with oils that cause skin allergies.
- Metals such as chrome and mercury.
- Latex, found in products such as rubber toys, balloons, balls, rubber gloves, bandages, and pacifiers or nipples.
- Cosmetics, including permanent hair dye that contains paraphenylenediamine, dyes used in clothing, perfumes, eye shadow, nail polish, lipstick, and some sunscreens.
- Medications such as neomycin, found in antibiotic creams, and local anaesthetics.
If your toddler has allergic contact dermatitis, it is important to identify and avoid the substances that may have caused it. Treatment may include cool cloths, dressings, skin creams or lotions, or prescription medicines. For severe reactions, always contact your toddler's doctor.
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Frequently asked questions
There could be several reasons for this, including injury, viral infection, or an underlying condition such as a fungal infection, psoriasis, or hyperthyroidism. In some cases, it may be a result of repetitive trauma, such as from repeatedly tapping nails.
It is recommended to consult a doctor to determine the underlying cause and receive appropriate treatment. In the meantime, general measures to support nail health include keeping the nails trimmed short and avoiding potential irritants, such as nail products.
On average, fingernails in healthy US adults grow about 3.47 mm per month. However, it may take 4 to 6 months for a fingernail to reach its full size again after being detached.
Yes, it is important to monitor the wound for any signs of infection. Some signs may include pus drainage, swollen lymph nodes in the neck, armpits, or groin, and colour changes or bloody crusting around the wound.
