Distolateral subungual onychomycosis in children successfully treated with topical 2% ketoconazole lotion

Onychomycosis is a chronic fungal infection caused by dermatophytes or yeasts which lead to the destruction of the nail plate of the hands and feet. Onychomycosis is rare in children, but its prevalence is reported to increase in children and adolescents, accounting for 20% of all dermatophyte infections. Distolateral subungual onychomycosis (DLSO) is the most common clinical form. Treatment of onychomycosis depends on several factors including the severity of the nail, the efficacy and the potential side effects of the treatment regimen. Usually onychomycosis in children treated with combination of systemic and topical therapy. And usually patient treated with topical therapies alone don't give a satisfactory result.
We report a case of Distolateral Subungual Onychomycosis in an 11-year-old girl with nail dystrophy on the hand and foot in the last 3 months. Physical examination showed found discoloration and subungual keratosis on the third fingernail and on the third and four toenails. Fungal culture from the toenail and fingernail scraping showed the growth of T. rubrum and T. schoenleinii, respectively. Based on the history taking, physical examination, and supporting examination, a diagnosis of onychomycosis was made. The patient responded well to a topical application of 2% Ketoconazole lotion after 20 days.