Answered by Anthony Mancini M.D.
Dr. Mancini received his undergraduate and medical educations at the University of Arizona, and trained in pediatrics, pediatric dermatology, and dermatology at Stanford University. He is currently Associate Professor of Pediatrics and Dermatology at Northwestern University's Feinberg School of Medicine and Head of the Division of Dermatology at Children's Memorial Hospital in Chicago, Illinois.
Dr. Mancini has served as a member of the AAP Executive Committee, Section of Dermatology since 2001. He is a member of the AAP Super CME Planning Group and the AAP Pedia Link Pediatric Dermatology Project Team, and is Secretary-Treasurer of the Society for Pediatric Dermatology. His teaching accomplishments include the Faculty Excellence in Education Award from the Department of Pediatrics at Northwestern, which he has received for the last eight years. Dr. Mancini is a peer reviewer and/or sits on the editorial board for several academic journals, and has published over 75 peer-reviewed articles, abstracts, and book chapters. He is co-author of Hurwitz Clinical Pediatric Dermatology, 3rd edition, and is an associate editor for the comprehensive dermatology textbook Dermatology. His special interests include infectious skin diseases and exanthems of childhood, vascular malformations and hemangiomas, and neonatal skin maturation and skin disorders.
Dr. Mancini is a Fellow of the American Academy of Pediatrics and the American Academy of Dermatology. He and his wife, Nicola, a neonatal intensive care nurse, have three children (Mallory, Christopher, and Mackenzie) and reside in Evanston, Illinois.
Question
What can we do about my 4-year-old's thick, black toenails?
Answer
While toenails can become thickened for various reasons (such as fungal infection, psoriasis, etc.), your observation that the same changes are seen in your husband is important. You didn't mention the ethnic background of these loved ones, but sometimes the nails of individuals with darkly pigmented skin can darken and thicken as a normal variant. There is also a genetic disorder called "pachyonychia congenita" that causes thickened nails, thickened skin on the palms and soles, and white patches inside the cheeks.
Aside from fungal nail infections, most of these nail changes are difficult to treat, but there are some therapies that might help. And although some would consider treatment to be "cosmetic," these nail changes could make a young child self-conscious and could even affect walking or running. Have your daughter evaluated by a dermatologist or podiatrist (foot doctor), so you can get to the root of the cause and learn about possible treatments.
