Q: My daughter is 3.5 years old. Since last two months her nails on both feet have become dark brown, thick and ugly. It seems that the nails have been dried from inside and when we try to cut the nails some white powder comes from them. I went to a skin specialist in the beginning of this problem and he suspected this to be twenty-nail dystrophy and he said her all nails will become like this. But her nails on fingers are still normal. We are applying olive oil on her nails and the nails have got slightly better than earlier. Could you please advise for treatment?

A:Thick, ugly and dark brown nails are encountered in a number of conditions like fungal infection, psoriasis, lichen planus, etc. Fungal infections are a common cause of such nail changes. However, I rarely see them in children who do not wear shoes most of the time. The doubt can easily be cleared by a simple KOH examination of subungual scrapes. The other conditions are usually associated with other tell-tale signs elsewhere on the skin. In a small number of cases, no cause can be found.