Utility of devices for onychomycosis: a review

Onychomycosis is a hard-to-treat fungal infection of the nail unit; high complete cure and mycological cure rates remain elusive.

Many oral and topical antifungal agents are approved by regulatory bodies around the world for the treatment of onychomycosis including terbinafine, itraconazole, 10% efinaconazole, 5% tavaborole, and 8% ciclopirox. These agents have varying rates of success in clinical studies, with limitations such as long treatment durations, drug interactions, low patient compliance, and high relapse rates.

Device-based treatments are targeted to specific regions of the nail, have favorable safely profiles, and do not interfere with systemic agents. They may be an effective alternative therapy for onychomycosis especially with increasing reports of squalene epoxidase gene mutations and potential resistance to terbinafine therapy.

This review discusses four devices used as antifungal treatments and three devices used as penetration enhancers for topical agents. Lasers, photodynamic therapy, microwaves, and non-thermal plasma have the capacity to inactivate fungal pathogens demonstrated through in vivo studies.