Understanding the formidable nail barrier: A review of the nail microstructure, composition and diseases

Mycoses. 2017 May;60(5):284-295. doi: 10.1111/myc.12592. Epub 2017 Jan 18.


The topical treatment of nail fungal infections has been a focal point of nail research in the past few decades as it offers a much safer and focused alternative to conventional oral therapy. Although the current focus remains on exploring the ways of enhancing permeation through the formidable nail barrier, the understanding of the nail microstructure and composition is far from complete. This article reviews our current understanding of the nail microstructure, composition and diseases. A few of the parameters affecting the nail permeability and potential causes of the recurrence of fungal nail infection are also discussed.

Keywords: anti-fungal; iontophoresis; keratin; laser treatment; nails; onychomycosis.

Publication types

  • Review

MeSH terms

  • Administration, Topical
  • Antifungal Agents / administration & dosage
  • Antifungal Agents / pharmacokinetics*
  • Antifungal Agents / therapeutic use
  • Humans
  • Hydrogen-Ion Concentration
  • Microscopy, Electron, Scanning
  • Nails / chemistry
  • Nails / metabolism*
  • Nails / pathology
  • Nails / ultrastructure*
  • Onychomycosis / drug therapy*
  • Onychomycosis / metabolism
  • Onychomycosis / microbiology
  • Onychomycosis / pathology
  • Permeability


  • Antifungal Agents