Abstract
Despite promising pharmacodynamic and pharmacokinetic profiles, modern antifungals exhibit limited efficacy in the treatment of onychomycoses. The clinical and mycological data are far from reaching a complete cure even after long-course treatments extending over many months. After reviewing the histological presentation of onychomycoses, one of the main reasons for treatment failure and disease recurrence appears to be the presence of dormant chlamydospores and arthroconidia inside the infected nail plate. Accordingly, we present a novel concept in onychomycosis treatment. It consists of the combination of an antifungal with a device boosting germination of fungal propagules in order to render these cells more responsive to treatment. Preliminary results of a pilot study support such a concept.