Peeling fingernails in a 5‐year‐old

1. PATIENT PRESENTATION

A healthy 5‐year‐old female presented to the emergency department with nails falling off bilaterally from her hands. The child denied redness, injury, pain, discharge, or similar episodes in the past. The mother reported intermittent fever and cough for 2 weeks. Physical examination revealed onychomadesis on multiple fingers (Figure 1).

FIGURE 1.

Onychomadesis (proximal nail plate separation from the nail matrix and nail bed) on the patient's third and fourth fingers.

2. DIAGNOSIS: POSTCOVID‐19 ONYCHOMADESIS

This patient presented to the emergency department 2 weeks prior and was admitted for acute COVID‐19 infection and evaluation for multisystem inflammatory syndrome in children. At that time, the patient presented with erythema and peeling of the fingertips bilaterally (Figure 2).

FIGURE 2.

Erythema and peeling of the patient's fingertips bilaterally on initial presentation 2 weeks prior.

There are many nonspecific sequelae of COVID‐19 involving the nails. ¹ , ² In adults, onychomadesis has been reported. ³ However, there are very few cases documented in the pediatric populations. ⁴ , ⁵ The mechanism of onychomadesis in unclear; however, onychomadesis has been documented in the setting of other viral illnesses, such as non‐SARS‐CoV2 coronavirus, enterovirus, and coxsackievirus. ⁴ , ⁶ , ⁷ The prognosis for post‐viral onychomadesis is generally good, so the patient was discharged home with referral for dermatology follow‐up and instruction to use topical emollient if the nail bed became exposed.

Smith B, Hassoun A. Peeling fingernails in a 5‐year‐old. JACEP Open. 2023;4:e12945. 10.1002/emp2.12945