Skip to main content
Erschienen in: Current Fungal Infection Reports 4/2018

29.10.2018 | Fungal Infections of Skin and Subcutaneous Tissue (A Bonifaz, Section Editor)

Onychomycosis in Children with Down Syndrome

verfasst von: Jade Castellanos, Mirna Toledo-Bahena, Carlos Mena-Cedillos, Erika Ramirez-Cortes, Adriana Valencia-Herrera

Erschienen in: Current Fungal Infection Reports | Ausgabe 4/2018

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

Fungal infection of the nail, known as onychomycosis, occurs more frequently in older age, showing a higher prevalence in pediatric age in recent years. A high rate of dermatological infections befalls in patients with Down syndrome, including onychomycosis, due to a decrease in T and B lymphocytes in number and function, resulting in a disarrangement of cellular and humoral immunity. This has led to several investigations on onychomycosis in children with Down syndrome, so the purpose of this review is to show the available evidence.

Recent Findings

The etiological agents of onychomycosis can be dermatophytes, non-dermatophyte molds, and yeasts. Most cases are related with dermatophytes; Trichophyton rubrum being the most common cause. In children with Down syndrome, T. rubrum has been reported as the main cause, followed by T. mentagrophytes. Distal lateral subungual onychomycosis is the most common variety of onychomycosis in children. The importance of identifying the fungus lies in selecting the appropriate treatment, since not all antifungals have the same spectrum of action against molds and Candida. Terbinafine has showed to be safe and effective for the treatment of onychomycosis in patients from special populations, including children with Down syndrome. In patients with Down syndrome, treatment for onychomycosis has not been completely studied; so far, terbinafine has shown the best results.

Summary

The clinical presentations of children with Down syndrome and the rest of the general pediatric population are similar. However, there are few studies about onychomycosis in children with Down syndrome. It is necessary to perform new onychomycosis research in this study population, in order to establish recommendations.
Literatur
1.
Zurück zum Zitat • Solís-Arias M, García-Romero M. Onychomycosis in children. A review. Int J Dermatol. 2016;56:123–30. The clinical and therapeutic characteristics of onychomycosis in pediatric population are described. CrossRef • Solís-Arias M, García-Romero M. Onychomycosis in children. A review. Int J Dermatol. 2016;56:123–30. The clinical and therapeutic characteristics of onychomycosis in pediatric population are described. CrossRef
2.
Zurück zum Zitat Kaur R, Kashyap B, Makkar R. Evaluation of clinicomycological aspects of onychomycosis. Indian J Dermatol. 2008;53:174–8.CrossRef Kaur R, Kashyap B, Makkar R. Evaluation of clinicomycological aspects of onychomycosis. Indian J Dermatol. 2008;53:174–8.CrossRef
3.
Zurück zum Zitat • Gupta AK, Sibbald RG, Lynde CW, et al. Onychomycosis in children: prevalence and treatment strategies. J Am Acad Dermatol. 1997;36:395–402. Complete review of clinical and therapeutic aspects of onychomycosis in children. CrossRef • Gupta AK, Sibbald RG, Lynde CW, et al. Onychomycosis in children: prevalence and treatment strategies. J Am Acad Dermatol. 1997;36:395–402. Complete review of clinical and therapeutic aspects of onychomycosis in children. CrossRef
4.
Zurück zum Zitat Morales Mendoza Y, Arenas GR. Onicomicosis en pacientes pediátricos: un giro epidemiológico y un reto terapéutico. Dermatol Rev Mex. 2012;56:115–8. Morales Mendoza Y, Arenas GR. Onicomicosis en pacientes pediátricos: un giro epidemiológico y un reto terapéutico. Dermatol Rev Mex. 2012;56:115–8.
5.
Zurück zum Zitat Midgley G, Moore MK, Cook JC, Phan QG. Mycology of nail disorders. J Am Acad Dermatol. 1994;31:S68–74.CrossRef Midgley G, Moore MK, Cook JC, Phan QG. Mycology of nail disorders. J Am Acad Dermatol. 1994;31:S68–74.CrossRef
6.
Zurück zum Zitat Schepis C, Barone C, Siragusa M, Pettinato R, Romano C. An updated survey on skin conditions in down syndrome. Dermatology. 2002;205:234–8.CrossRef Schepis C, Barone C, Siragusa M, Pettinato R, Romano C. An updated survey on skin conditions in down syndrome. Dermatology. 2002;205:234–8.CrossRef
7.
Zurück zum Zitat Nespoli L, Burgio GR, Ugazio AG, et al. Immunological features of Down’s syndrome: a review. J Intellect Disabil Res. 1993;37:543–51.CrossRef Nespoli L, Burgio GR, Ugazio AG, et al. Immunological features of Down’s syndrome: a review. J Intellect Disabil Res. 1993;37:543–51.CrossRef
8.
Zurück zum Zitat Pozo Cano M, González Jiménez E, Álvarez Ferre J, et al. La piel y su expresión en la clínica del niño con síndrome de Down. Rev Med Int Síndr Down. 2011;15:23–5.CrossRef Pozo Cano M, González Jiménez E, Álvarez Ferre J, et al. La piel y su expresión en la clínica del niño con síndrome de Down. Rev Med Int Síndr Down. 2011;15:23–5.CrossRef
9.
Zurück zum Zitat Roat E, Prada N, Lugli E, Nasi M, Ferraresi R, Troiano L, et al. Homeostatic cytokines and expansion of regulatory T cells accompany thymic impairment in children with Down syndrome. Rejuvenation Res. 2008;11:573–83.CrossRef Roat E, Prada N, Lugli E, Nasi M, Ferraresi R, Troiano L, et al. Homeostatic cytokines and expansion of regulatory T cells accompany thymic impairment in children with Down syndrome. Rejuvenation Res. 2008;11:573–83.CrossRef
10.
Zurück zum Zitat Kusters M, Verstegen R, Gemen E, de Vries E. Intrinsic defect of the immune system in children with Down syndrome: a review. J Clin Exp Immunol. 2009;156:189–93.CrossRef Kusters M, Verstegen R, Gemen E, de Vries E. Intrinsic defect of the immune system in children with Down syndrome: a review. J Clin Exp Immunol. 2009;156:189–93.CrossRef
11.
Zurück zum Zitat De Hingh Y, van der Vossen P, Gemen E, et al. Intrinsic abnormalities of lymphocyte counts in children with down syndrome. J Pediatr. 2005;147:744–7.CrossRef De Hingh Y, van der Vossen P, Gemen E, et al. Intrinsic abnormalities of lymphocyte counts in children with down syndrome. J Pediatr. 2005;147:744–7.CrossRef
12.
Zurück zum Zitat Ram G, Chinen J. Infections and immunodeficiency in down syndrome. J Clin Exp Immunol. 2011;164:9–16.CrossRef Ram G, Chinen J. Infections and immunodeficiency in down syndrome. J Clin Exp Immunol. 2011;164:9–16.CrossRef
13.
Zurück zum Zitat • Velthuis P, Nijenhuis M. Treatment of onychomycosis with terbinafine in patients with Down’s syndrome. Br J Dermatol. 2006;133:144–6. The results of the cultures carried out on patients with Down syndrome and onychomycosis are described. CrossRef • Velthuis P, Nijenhuis M. Treatment of onychomycosis with terbinafine in patients with Down’s syndrome. Br J Dermatol. 2006;133:144–6. The results of the cultures carried out on patients with Down syndrome and onychomycosis are described. CrossRef
14.
Zurück zum Zitat Chang P, Ucelo ZMQ, Del Pilar Garzaro Chávez HM. Onychomycosis and immunodepression. Curr Fungal Infect Rep. 2017;11:252–7.CrossRef Chang P, Ucelo ZMQ, Del Pilar Garzaro Chávez HM. Onychomycosis and immunodepression. Curr Fungal Infect Rep. 2017;11:252–7.CrossRef
15.
Zurück zum Zitat Whittingham S, Sharma D, Pitt D, Mackay I. Stress deficiency of the T-lymphocyte system exemplified by Down syndrome. Lancet. 1977;309:163–6.CrossRef Whittingham S, Sharma D, Pitt D, Mackay I. Stress deficiency of the T-lymphocyte system exemplified by Down syndrome. Lancet. 1977;309:163–6.CrossRef
16.
Zurück zum Zitat Wagner D, Sohnle P. Cutaneous defenses against dermatophytes and yeasts. Clin Microbiol Rev. 1995;8:317–35.CrossRef Wagner D, Sohnle P. Cutaneous defenses against dermatophytes and yeasts. Clin Microbiol Rev. 1995;8:317–35.CrossRef
17.
Zurück zum Zitat Vásquez-del Mercado E, Arenas R. Onicomicosis en niños. Estudio retrospectivo de 233 casos mexicanos. Gac Med Mex. 2008;144:7–10.PubMed Vásquez-del Mercado E, Arenas R. Onicomicosis en niños. Estudio retrospectivo de 233 casos mexicanos. Gac Med Mex. 2008;144:7–10.PubMed
18.
Zurück zum Zitat Ameen M, Lear JT, Madan V, Mohd Mustapa MF, Richardson M. British Association of Dermatologists’ guidelines for the management of onychomycosis. Br J Dermatol. 2014;171:937–58.CrossRef Ameen M, Lear JT, Madan V, Mohd Mustapa MF, Richardson M. British Association of Dermatologists’ guidelines for the management of onychomycosis. Br J Dermatol. 2014;171:937–58.CrossRef
19.
Zurück zum Zitat Rodríguez-Pazos L, Pereiro-Ferreiros MM, Pereiro M Jr, et al. Onychomycosis observed in children over a 20-year period. Mycoses. 2011;54:450–3.CrossRef Rodríguez-Pazos L, Pereiro-Ferreiros MM, Pereiro M Jr, et al. Onychomycosis observed in children over a 20-year period. Mycoses. 2011;54:450–3.CrossRef
20.
Zurück zum Zitat Young LS, Arbuckle HA, Morelli JG. Onychomycosis in the Denver pediatrics population, a retrospective study. Pediatr Dermatol. 2014;31:106–8.CrossRef Young LS, Arbuckle HA, Morelli JG. Onychomycosis in the Denver pediatrics population, a retrospective study. Pediatr Dermatol. 2014;31:106–8.CrossRef
21.
Zurück zum Zitat Iglesias A, Tamayo L, Sosa-de-Martínez C, et al. Prevalence and nature of nail alterations in pediatric patients. Pediatr Dermatol. 2001;2:107–9.CrossRef Iglesias A, Tamayo L, Sosa-de-Martínez C, et al. Prevalence and nature of nail alterations in pediatric patients. Pediatr Dermatol. 2001;2:107–9.CrossRef
22.
Zurück zum Zitat Elewski BE. Onychomycosis: pathogenesis, diagnosis and management. Clin Microbiol Rev. 1998;11:415–29.CrossRef Elewski BE. Onychomycosis: pathogenesis, diagnosis and management. Clin Microbiol Rev. 1998;11:415–29.CrossRef
23.
Zurück zum Zitat Araníbar L, Villagrán B, Merino D, et al. Dermatologic disorders in patients with Down syndrome in Santiago, Chile. J Am Acad Dermatol. 2009;60:AB145. Araníbar L, Villagrán B, Merino D, et al. Dermatologic disorders in patients with Down syndrome in Santiago, Chile. J Am Acad Dermatol. 2009;60:AB145.
24.
Zurück zum Zitat •• Carter D, Jegasothy B. Alopecia areata and Down syndrome. Arch Dermatol. 1976;112:1397–9 This is the biggest research about onychomycosis in Down syndrome ever reported.CrossRef •• Carter D, Jegasothy B. Alopecia areata and Down syndrome. Arch Dermatol. 1976;112:1397–9 This is the biggest research about onychomycosis in Down syndrome ever reported.CrossRef
25.
Zurück zum Zitat Polenghi MM, Plattoni F, Orsini GB, et al. Dermatologic disorders in Down syndrome. Am J Med Genet. 1990;7:324. Polenghi MM, Plattoni F, Orsini GB, et al. Dermatologic disorders in Down syndrome. Am J Med Genet. 1990;7:324.
26.
Zurück zum Zitat • Ghannoum M, Mukherjee P, Isham N, et al. Examining the importance of laboratory and diagnostic testing when treating and diagnosing onychomycosis. Int J Dermatol. 2017;57:131–8. It is a very complete review about the diagnosis and treatment of onychomycosis. CrossRef • Ghannoum M, Mukherjee P, Isham N, et al. Examining the importance of laboratory and diagnostic testing when treating and diagnosing onychomycosis. Int J Dermatol. 2017;57:131–8. It is a very complete review about the diagnosis and treatment of onychomycosis. CrossRef
27.
Zurück zum Zitat Ercis M, Balci S, Atakan N. Dermatological manifestations of 71 Down syndrome children admitted to a clinical genetics unit. Clin Genet. 2008;50:317–20.CrossRef Ercis M, Balci S, Atakan N. Dermatological manifestations of 71 Down syndrome children admitted to a clinical genetics unit. Clin Genet. 2008;50:317–20.CrossRef
28.
Zurück zum Zitat Bonifaz A, Saúl A, Mena C, Valencia A, Paredes V, Fierro L, et al. Dermatophyte onychomycosis in children under 2 years of age: experience of 16 cases. J Eur Acad Dermatol Venereol. 2007;21:115–7.CrossRef Bonifaz A, Saúl A, Mena C, Valencia A, Paredes V, Fierro L, et al. Dermatophyte onychomycosis in children under 2 years of age: experience of 16 cases. J Eur Acad Dermatol Venereol. 2007;21:115–7.CrossRef
29.
Zurück zum Zitat Daneshpazhooh M, Mohammad-Javad NT, Bigdelu L, et al. Mucocutaneous findings in 100 children with Down syndrome. Pediatr Dermatol. 2007;24:317–20.CrossRef Daneshpazhooh M, Mohammad-Javad NT, Bigdelu L, et al. Mucocutaneous findings in 100 children with Down syndrome. Pediatr Dermatol. 2007;24:317–20.CrossRef
30.
Zurück zum Zitat Sureshbabu R, Kumari R, Ranugha S, et al. Phenotypic and dermatological manifestations in Down syndrome. Dermatol Online J. 2011;2:1–12.CrossRef Sureshbabu R, Kumari R, Ranugha S, et al. Phenotypic and dermatological manifestations in Down syndrome. Dermatol Online J. 2011;2:1–12.CrossRef
31.
Zurück zum Zitat Chu D, Rubin A. Diagnosis and management of nail disorders in children. Pediatr Clin N Am. 2014;61:293–308.CrossRef Chu D, Rubin A. Diagnosis and management of nail disorders in children. Pediatr Clin N Am. 2014;61:293–308.CrossRef
32.
Zurück zum Zitat Córdoba ME, Arenas R, López C, et al. Síndrome de Down. Frecuencia y características de la onicomicosis de los pies. Dermatol Rev Mex. 2000;44:5–9. Córdoba ME, Arenas R, López C, et al. Síndrome de Down. Frecuencia y características de la onicomicosis de los pies. Dermatol Rev Mex. 2000;44:5–9.
33.
Zurück zum Zitat Tosti A, Piraccini BM, Lorenzi S. Onychomycosis caused by nondermatophytic molds: clinical features and response to treatment of 59 cases. J Am Acad Dermatol. 2000;42:217–24.CrossRef Tosti A, Piraccini BM, Lorenzi S. Onychomycosis caused by nondermatophytic molds: clinical features and response to treatment of 59 cases. J Am Acad Dermatol. 2000;42:217–24.CrossRef
34.
Zurück zum Zitat Ramani R, Srinivas CR, Ramani A, et al. Molds in onychomycosis. Int J Dermatol. 1993;32:877–8.CrossRef Ramani R, Srinivas CR, Ramani A, et al. Molds in onychomycosis. Int J Dermatol. 1993;32:877–8.CrossRef
35.
Zurück zum Zitat Bonifaz A, Cruz-Aguilar P, Ponce RM. Onychomycosis by molds. Report of 78 cases. Eur J Dermatol. 2007;17:70–2.PubMed Bonifaz A, Cruz-Aguilar P, Ponce RM. Onychomycosis by molds. Report of 78 cases. Eur J Dermatol. 2007;17:70–2.PubMed
36.
Zurück zum Zitat Hwang SM, et al. Onychomycosis due to nondermatophytic molds. Ann Dermatol. 2012;2:175–80.CrossRef Hwang SM, et al. Onychomycosis due to nondermatophytic molds. Ann Dermatol. 2012;2:175–80.CrossRef
37.
Zurück zum Zitat Gupta AK, et al. Systematic review of nondermatophyte mold onychomycosis: diagnosis, clinical types, epidemiology, and treatment. J Am Acad Dermatol. 2012;3:494–502.CrossRef Gupta AK, et al. Systematic review of nondermatophyte mold onychomycosis: diagnosis, clinical types, epidemiology, and treatment. J Am Acad Dermatol. 2012;3:494–502.CrossRef
38.
Zurück zum Zitat Bonifaz A. Micología Médica Básica. 5th ed. Ciudad de México: McGraw-Hill; 2015. Bonifaz A. Micología Médica Básica. 5th ed. Ciudad de México: McGraw-Hill; 2015.
39.
Zurück zum Zitat Fletcher CL, Moore MK, Hay RJ. Endonyx onychomycosis due to trichophyton soudanense in two Somalian siblings. Br J Dermatol. 2001;145:687–8.CrossRef Fletcher CL, Moore MK, Hay RJ. Endonyx onychomycosis due to trichophyton soudanense in two Somalian siblings. Br J Dermatol. 2001;145:687–8.CrossRef
40.
Zurück zum Zitat Velasquez-Agudelo V, Cardona-Arias JA. Meta-analysis of the utility of culture, biopsy, and direct KOH examination for the diagnosis of onychomycosis. BMC Infect Dis. 2017;17:166.CrossRef Velasquez-Agudelo V, Cardona-Arias JA. Meta-analysis of the utility of culture, biopsy, and direct KOH examination for the diagnosis of onychomycosis. BMC Infect Dis. 2017;17:166.CrossRef
41.
Zurück zum Zitat Elewski BE. Clinical pearl: diagnosis of onychomycosis. J Am Acad Dermatol. 1995;32:500–1.CrossRef Elewski BE. Clinical pearl: diagnosis of onychomycosis. J Am Acad Dermatol. 1995;32:500–1.CrossRef
42.
Zurück zum Zitat Gupta A, Ryder J, Skinner A. Treatment of onychomycosis: pros and cons of antifungal agents. J Cutan Med Surg. 2004;8:25–30.CrossRef Gupta A, Ryder J, Skinner A. Treatment of onychomycosis: pros and cons of antifungal agents. J Cutan Med Surg. 2004;8:25–30.CrossRef
43.
Zurück zum Zitat Westerberg DP, Voyack MJ. Onychomycosis. Am Fam Physician. 2013;88:762–70.PubMed Westerberg DP, Voyack MJ. Onychomycosis. Am Fam Physician. 2013;88:762–70.PubMed
44.
Zurück zum Zitat Kreijkamp-Kaspers S, Hawke K, van Driel M. Oral medications to treat toenail fungal infection. JAMA. 2018;319:97.CrossRef Kreijkamp-Kaspers S, Hawke K, van Driel M. Oral medications to treat toenail fungal infection. JAMA. 2018;319:97.CrossRef
45.
Zurück zum Zitat Gupta A, Del Rosso J. An evaluation of intermittent therapies used to treat onychomycosis and other dermatomycoses with the oral antifungal agents. Int J Dermatol. 2000;39:401–11.CrossRef Gupta A, Del Rosso J. An evaluation of intermittent therapies used to treat onychomycosis and other dermatomycoses with the oral antifungal agents. Int J Dermatol. 2000;39:401–11.CrossRef
46.
Zurück zum Zitat De Doncker P, Decroix J, Piérard GE, et al. Antifungal pulse therapy for onychomycosis. Arch Dermatol. 1996;132:34–41.CrossRef De Doncker P, Decroix J, Piérard GE, et al. Antifungal pulse therapy for onychomycosis. Arch Dermatol. 1996;132:34–41.CrossRef
47.
Zurück zum Zitat De Doncker P, Gupta A, Marynissen G, et al. Itraconazole pulse therapy for onychomycosis and dermatomycoses: an overview. J Am Acad Dermatol. 1997;37:969–74.CrossRef De Doncker P, Gupta A, Marynissen G, et al. Itraconazole pulse therapy for onychomycosis and dermatomycoses: an overview. J Am Acad Dermatol. 1997;37:969–74.CrossRef
48.
Zurück zum Zitat Friedlander S, Chan Y, Chan Y, et al. Onychomycosis does not always require systemic treatment for cure: a trial using topical therapy. Pediatr Dermatol. 2012;30:316–22.CrossRef Friedlander S, Chan Y, Chan Y, et al. Onychomycosis does not always require systemic treatment for cure: a trial using topical therapy. Pediatr Dermatol. 2012;30:316–22.CrossRef
49.
Zurück zum Zitat Gupta A, Ryder J, Lynch L, et al. The use of terbinafine in the treatment of onychomycosis in adults and special populations: a review of the evidence. J Drugs Dermatol. 2005;4:302–7.PubMed Gupta A, Ryder J, Lynch L, et al. The use of terbinafine in the treatment of onychomycosis in adults and special populations: a review of the evidence. J Drugs Dermatol. 2005;4:302–7.PubMed
50.
Zurück zum Zitat Restrepo C, Correa L, Velásquez M. Manifestaciones cutáneas en pacientes con Síndrome de Down. Rev Asoc Colomb Dermatol. 2013;21:57–68. Restrepo C, Correa L, Velásquez M. Manifestaciones cutáneas en pacientes con Síndrome de Down. Rev Asoc Colomb Dermatol. 2013;21:57–68.
Metadaten
Titel
Onychomycosis in Children with Down Syndrome
verfasst von
Jade Castellanos
Mirna Toledo-Bahena
Carlos Mena-Cedillos
Erika Ramirez-Cortes
Adriana Valencia-Herrera
Publikationsdatum
29.10.2018
Verlag
Springer US
Erschienen in
Current Fungal Infection Reports / Ausgabe 4/2018
Print ISSN: 1936-3761
Elektronische ISSN: 1936-377X
DOI
https://doi.org/10.1007/s12281-018-0331-z

Weitere Artikel der Ausgabe 4/2018

Current Fungal Infection Reports 4/2018 Zur Ausgabe

Current Management of Fungal Infections (J Maertens, Section Editor)

Patients with Primary Immunodeficiencies: How Are They at Risk for Fungal Disease?

Current Management of Fungal Infections (J Maertens, Section Editor)

Diagnosing Invasive Mold Infections: What Is Next

Fungal Infections of Skin and Subcutaneous (A Bonifaz, Section Editor)

Association of Malassezia to Atopic Dermatitis

Current Management of Fungal Infections (J Maertens, Section Editor)

Cryptococcosis in Patients with Hematologic Diseases

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.