Onychomycosis: Treatment and prevention of recurrence

J Am Acad Dermatol. 2019 Apr;80(4):853-867. doi: 10.1016/j.jaad.2018.05.1260. Epub 2018 Jun 28.


Onychomycosis is a fungal nail infection caused by dermatophytes, nondermatophytes, and yeast, and is the most common nail disorder seen in clinical practice. It is an important problem because it may cause local pain, paresthesias, difficulties performing activities of daily living, and impair social interactions. The epidemiology, risk factors, and clinical presentation and diagnosis of onychomycosis were discussed in the first article in this continuing medical education series. In this article, we review the prognosis and response to onychomycosis treatment, medications for onychomycosis that have been approved by the US Food and Drug Administration, and off-label therapies and devices. Methods to prevent onychomycosis recurrences and emerging therapies are also described.

Keywords: booster therapy; ciclopirox; clinical cure; complete cure; efinaconazole; fluconazole; fungal nail infection; itraconazole; lasers; mycologic cure; onychomycosis; photodynamic therapy; plasma therapy; pulse dosing; tavaborole; terbinafine; treatment.

Publication types

  • Review

MeSH terms

  • Antifungal Agents / therapeutic use*
  • Boron Compounds / therapeutic use
  • Bridged Bicyclo Compounds, Heterocyclic / therapeutic use
  • Ciclopirox / therapeutic use
  • Fluconazole / therapeutic use
  • Humans
  • Itraconazole / therapeutic use
  • Laser Therapy
  • Nanoparticles / therapeutic use
  • Onychomycosis / drug therapy*
  • Onychomycosis / prevention & control
  • Onychomycosis / therapy
  • Photochemotherapy
  • Plasma Gases
  • Prognosis
  • Pulse Therapy, Drug
  • Risk Factors
  • Secondary Prevention*
  • Severity of Illness Index
  • Terbinafine / therapeutic use
  • Triazoles / therapeutic use


  • Antifungal Agents
  • Boron Compounds
  • Bridged Bicyclo Compounds, Heterocyclic
  • Plasma Gases
  • Triazoles
  • Ciclopirox
  • Itraconazole
  • Fluconazole
  • Terbinafine
  • efinaconazole
  • tavaborole