Onychomycosis in the 21st Century: An Update on Diagnosis, Epidemiology, and Treatment

J Cutan Med Surg. 2017 Nov/Dec;21(6):525-539. doi: 10.1177/1203475417716362. Epub 2017 Jun 22.


Onychomycosis accounts for 50% of all nail disease cases and is commonly caused by dermatophytes. Diabetes, human immunodeficiency virus, immunosuppression, obesity, smoking, and advancing age are predisposing factors of this fungal infection. Potassium hydroxide and culture are considered the current standard for diagnosing onychomycosis, revealing both fungal viability and species identification. Other diagnostic tests currently available include periodic acid-Schiff staining, polymerase chain reaction techniques, and fluorescent staining. Across 6 recently published epidemiology studies, the global prevalence of onychomycosis was estimated to be 5.5%, falling within the range of previously reported estimates (2%-8%). Newly approved onychomycosis treatments include efinaconazole, tavaborole, and laser therapy with lasers only approved to temporarily increase the amount of clear nail. Additional onychomycosis treatments being investigated include iontophoresis and photodynamic therapy with small open-label studies reported thus far. Preventative strategies, to help decrease recurrence and reinfection rates, include sanitisation of footwear and prophylactic topical antifungal agents.

Keywords: diagnosis; epidemiology; onychomycosis; prevention; risk factors; treatment.

Publication types

  • Review

MeSH terms

  • Antifungal Agents / administration & dosage
  • Antifungal Agents / therapeutic use*
  • Humans
  • Laser Therapy
  • Microscopy
  • Molecular Diagnostic Techniques / economics
  • Mycological Typing Techniques / economics
  • Onychomycosis / diagnosis*
  • Onychomycosis / diagnostic imaging
  • Onychomycosis / epidemiology*
  • Onychomycosis / therapy*
  • Patient Care Planning
  • Photochemotherapy
  • Risk Factors
  • Secondary Prevention / methods


  • Antifungal Agents