Nail Surgery in Children: Specific Challenges and Practical Considerations

Nail surgery in children represents a specific field within dermatologic surgery. Although the procedures themselves are largely similar to those performed in adults, the indications, technical constraints, and perioperative management differ substantially. Pediatric nail disorders are often clinically recognizable, which frequently limits the need for invasive procedures. However, when surgery is indicated, it requires specific adaptations to ensure safety, diagnostic accuracy, and an acceptable experience for both the child and their parents. The small size of the pediatric nail unit, the thinner nail plate, and the child's limited tolerance to pain and immobility all influence surgical planning. Careful preoperative evaluation, appropriate counseling of parents, refined anesthetic techniques, and meticulous postoperative care are essential. The main procedures performed in children include nail biopsies, treatment of ingrowing toenails, excision of subungual exostosis and fibrokeratoma, surgery for congenital malalignment of the great toenail, and selected excisions for longitudinal melanonychia. In many situations, a conservative approach remains preferable, particularly when surgery carries a risk of permanent nail dystrophy or when the lesion may follow a benign natural course. Pediatric nail surgery therefore relies not only on technical expertise, but also on appropriate timing, close collaboration with caregivers and pathologists, and a constant effort to minimize trauma to the developing nail unit.