Case Report: Treatment of trachyonychia in children with crisaborole: a retrospective case series

Trachyonychia is a chronic nail disorder affecting children aged 3-12 years, characterized by nail plate roughness and longitudinal ridging. It exhibits pathological features similar to atopic dermatitis, including spongiotic edema and inflammatory cell infiltration of the nail epithelium. Most pediatric cases are idiopathic, and high-quality therapeutic evidence remains limited. Crisaborole, a novel nonsteroidal PDE4 inhibitor with potent anti-inflammatory activity, may represent a promising therapeutic strategy.

This retrospective study was conducted at the Department of Dermatology, Beijing Children's Hospital between April 2021 and September 2022. Thirteen children diagnosed with trachyonychia were enrolled, with onychomycosis excluded by KOH examination. All patients received topical crisaborole twice daily on the nail plates and nail folds with nightly occlusion. Outcomes were assessed at 6 and 12 weeks using PGA and FDLQI. Statistical analysis was performed using the Wilcoxon signed-rank test in SPSS 24.0, with P < 0.05 considered statistically significant.

Thirteen children (9 males, 4 females; mean age 7.7 ± 2.2 years) with 95 affected nails were analyzed. At week 6, 82.1% of nails showed significant clinical improvement, including 43.2% complete remission and 38.9% partial remission. PGA and FDLQI scores were significantly reduced (P < 0.05). At week 12, 48.5% of nails maintained complete remission. No severe adverse events were reported.

Crisaborole is effective, safe, and well-tolerated for pediatric trachyonychia with favorable compliance. Its small molecular weight facilitates nail matrix penetration and targets the shared inflammatory pathogenesis of trachyonychia and atopic dermatitis. Crisaborole therefore represents a promising and reliable therapeutic option for children with trachyonychia.