Clinical Patterns, Diagnostic Considerations, and Underlying Etiologies of Nail Discoloration in Pediatric Patients

¹Travis Jackson, BS, University of Missouri School of Medicine, Columbia, MO, USA

²Aspynn Owsley BS, Idaho College of Osteopathic Medicine, Meridian, ID, USA

³Donna Pham, MS, University of California, Riverside, Riverside, CA, USA

⁴Lynn Fadel, BS, California Health Sciences University College of Osteopathic Medicine, USA

⁵Sabrina C. Camacho, BS, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX, USA

⁶Mary Virginia Glennon, BS, Medical College of Georgia, Augusta, GA, USA

⁷Ashley Bartlett, BS, University of New England College of Osteopathic Medicine, Biddeford, ME, USA

⁸Kelly Frasier, DO, MS - Northwell, New Hyde Park, NY, USA

*Corresponding author: Kelly Frasier, DO, MS, Department of Dermatology, Northwell Health, New Hyde Park, NY, United States, Phone: 3105956882, Email: [email protected]

Received : July 14, 2025
Published : March 04, 2026

ABSTRACT

Nail discoloration in pediatric populations encompasses a wide range of clinical presentations that serve as visible markers of localized trauma, nutritional deficiencies, infectious processes, inflammatory dermatoses, genetic syndromes, and systemic disease. Color changes may appear as isolated findings or in conjunction with systemic signs, providing valuable insight into underlying pathology. In younger children, white discoloration is frequently benign and related to microtrauma or nutritional deficiencies. Longitudinal melanonychia may reflect ethnic pigmentation or, in rare cases, nail matrix neoplasia. Bacterial infections, including Pseudomonas aeruginosa colonization, are implicated in green or brown nail changes in children with frequent aquatic exposure. Fungal infections are also common causes of nail discoloration, often presenting with yellow-brown discoloration. Inflammatory conditions such as psoriasis, along with systemic conditions such as Kawasaki disease, chronic renal or hepatic disease, and gastrointestinal malabsorption syndromes, may manifest as nail plate changes long before overt symptoms appear. Genetic and syndromic conditions, including ectodermal dysplasia, Darier disease, yellow nail syndrome, and nail-patella syndrome often initially present with nail changes, demonstrating how careful nail examination can facilitate early recognition of these disorders. Misinterpretation or dismissal of nail changes may delay early identification of underlying disease. A careful review of nail color, texture, distribution, and progression, combined with a thorough history- including systemic symptoms, physical exposures, and family history- can help narrow the differential diagnosis and improve diagnostic precision. Integrating nail assessment into routine examinations emphasizes its value as a non-invasive, high-yield clinical tool in uncovering both isolated and systemic disease processes in children. 

Keywords: Nail Discoloration, Pediatric Dermatology, Nutritional Deficiency, Systemic Disease, Infectious Nail Disorders, Genetic Syndromes

Citation: Jackson T, et al. (2026). Clinical Patterns, Diagnostic Considerations, and Underlying Etiologies of Nail Discoloration in Pediatric Patients. Dermis. 6(1):59.

Copyright: Jackson T, et al. © (2026).

ABSTRACT

Nail discoloration in pediatric populations encompasses a wide range of clinical presentations that serve as visible markers of localized trauma, nutritional deficiencies, infectious processes, inflammatory dermatoses, genetic syndromes, and systemic disease. Color changes may appear as isolated findings or in conjunction with systemic signs, providing valuable insight into underlying pathology. In younger children, white discoloration is frequently benign and related to microtrauma or nutritional deficiencies. Longitudinal melanonychia may reflect ethnic pigmentation or, in rare cases, nail matrix neoplasia. Bacterial infections, including Pseudomonas aeruginosa colonization, are implicated in green or brown nail changes in children with frequent aquatic exposure. Fungal infections are also common causes of nail discoloration, often presenting with yellow-brown discoloration. Inflammatory conditions such as psoriasis, along with systemic conditions such as Kawasaki disease, chronic renal or hepatic disease, and gastrointestinal malabsorption syndromes, may manifest as nail plate changes long before overt symptoms appear. Genetic and syndromic conditions, including ectodermal dysplasia, Darier disease, yellow nail syndrome, and nail-patella syndrome often initially present with nail changes, demonstrating how careful nail examination can facilitate early recognition of these disorders. Misinterpretation or dismissal of nail changes may delay early identification of underlying disease. A careful review of nail color, texture, distribution, and progression, combined with a thorough history- including systemic symptoms, physical exposures, and family history- can help narrow the differential diagnosis and improve diagnostic precision. Integrating nail assessment into routine examinations emphasizes its value as a non-invasive, high-yield clinical tool in uncovering both isolated and systemic disease processes in children. 

Keywords: Nail Discoloration, Pediatric Dermatology, Nutritional Deficiency, Systemic Disease, Infectious Nail Disorders, Genetic Syndromes.