FUNGAL INFECTIONS OF SKIN AND SUBCUTANEOUS TISSUE (A BONIFAZ, SECTION EDITOR)
The Efficacy and Safety of Systemic Antifungals
in Children’s Onychomycosis
Published online: 23 June 2017
Springer Science+Business Media, LLC 2017
Purpose of Review There are few reports about onychomycosis
in children with inconclusive results about the better and safer
option. We have observed and reported on the literature a sig-
nificant increase in the prevalence of onychomycosis in this age
Recent Findings Fungal infections, especially on the nails, are
common health diseases with increasing prevalence according
to age; however, it is rare in the pediatric population, except in
patients with Down syndrome and primary and secondary
Summary In this review, we focused on characteristics of chil-
dren’s onychomycosis as well as the efficacy and safety of
systemic antifungals, mainly terbinafine and itraconazole.
Clinicians must consider onychomycosis as the differential
diagnosis of nail disease in children and be aware of the ad-
verse events of systemic treatments in onychomycosis.
Onychomycosis is a common problem worldwide; it is estimat-
ed that 20–25% of the world’s population has skin infections
caused by fungi . Onychomycosis or fungal infection of the
nails is a common nail disorder comprising almost 40% of nail
diseases and 30% of superficial fungal infections [2, 3•].
Onychomycosis in children is less encountered than in
adults; therefore, epidemiological, clinical, and therapeutic
studies are scarce . In this review, we focused on these
characteristics of children’s onychomycosis due to dermato-
phytes and molds (non-dermatophytes) and the efficacy and
safety of systemic antifungals, mainly terbinafine and
itraconazole, which are the most commonly prescribed drugs
in clinical practice; however, these are off-label in children.
There is a lack of epidemiologic data about onychomycosis in
children compared to that in adults. The prevalence in children
˂16 years is reported between 0.2 and 2.6% [4–7, 8•, 9].
Gupta et al.  reported a prevalence of 0.44% in children
of North America, significantly higher than the worldwide
There is an increase in the worldwide prevalence of
onychomycosis in children [4–7, 8•, 9]. In a previous study
among Spanish children, onychomycosis represented 15.5% of
nail dystrophies. The same authors reported an increasing prev-
alence of onychomycosis from 3.2 to 31.1% in only 15 years .
Similarly, other studies showed an increased annual inci-
dence [6, 7, 8•, 9, 10, 11•]. This trend might be related to occlu-
sive synthetic footwear, communal locker rooms, public swim-
ming pools, and possibly inoculation from affected parents .
This article is part of the Topical Collection on Fungal Infections of Skin
and Subcutaneous Tissue
* Andrés Tirado-Sánchez
Dermatology Department, Hospital General de México, Dr. Balmis
148, Col. Doctores, Deleg. Cuauhtémoc, C.P. 06726 México
Dermatology Department, Instituto Mexicano del Seguro Social,
Ciudad de México, Mexico
Curr Fungal Infect Rep (2017) 11:104–109