Clinical tools for successful treatment of onychomycosis: a narrative review

Onychomycosis is a difficult-to-treat fungal infection of the human nail plate or bed that primarily affects the natural anatomy of human toe and finger nails, leading to a hard, brittle, and uneven nail surface. The severe structural mutilation of nails restricts the application of conventional formulations and makes onychomycosis therapy a challenging clinical premise. Oral therapy with drugs such as terbinafine hydrochloride and itraconazole may lead to drug interactions and systemic adverse effects, whereas topical treatment with drugs such as ciclopirox olamine and amorolfine are often associated with poor drug permeation through the nail bed. Recent advances in laser/photodynamic therapies and their application in onychomycosis has emerged as a new therapeutic paradigm with global acceptance. The present article is an attempt to provide an insight into onychomycosis and its manifestations, and summarises the various therapeutic modalities, with a greater focus on laser/photodynamic therapy.