💅 Onychomycosis Fungal Invasion & Treatment Comparator

Dermatophytes Breach the Nail Plate

Hyphae enter through small trauma sites at the nail edge.

• T. rubrum: Common pathogen (most frequent dermatophyte)
• Distal edge: Entry point (subungual space)
• ~10%: Global prevalence (adults affected)
• ~3 mm/mo: Nail growth rate (toenail baseline)

How invasion starts

Hyphae colonize keratin from the distal-lateral edge inward.

Discoloration and Thickening

Untreated infection spreads, causing visible nail damage.

• Yellow-brown: Color change (debris accumulation)
• 2-3x: Thickness increase (subungual hyperkeratosis)
• Months: Progression time (to full plate involvement)
• ~0%: Untreated cure (spontaneous resolution rare)

Structural damage

Nail becomes brittle, crumbly, and separated from the bed.

Systemic Oral Terbinafine Therapy

Pill delivers drug through blood to the growing nail bed.

• 12 weeks: Typical course (toenail regimen)
• ~63%: Cure rate (mycological cure)
• ~3 months: Onset (visible clear growth)
• ~20%: Recurrence (within 2 years)

Mechanism

Terbinafine accumulates in keratin via the nail bed circulation.

Topical Efinaconazole Application

Daily brush-on solution penetrates the nail plate directly.

• 48 weeks: Typical course (daily application)
• ~55%: Cure rate (complete/almost-complete)
• ~4 months: Onset (visible clear growth)
• ~30%: Recurrence (higher without systemic reach)

Mechanism

Low surface tension formula diffuses through the keratin matrix.

Laser-Based Antifungal Therapy

Focused laser heat aims to disrupt fungal cells in the nail bed.

• 3-4: Sessions (spaced over weeks)
• ~35%: Cure rate (variable evidence quality)
• ~2 months: Onset (fastest visible response)
• ~45%: Recurrence (highest among options)

Mechanism

Thermal energy targets fungal elements without systemic drug exposure.