title: Understanding the formidable nail barrier: A review of the nail microstructure, composition and diseases.
abstract: 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.
authors.affiliation: James L. Winkle College of Pharmacy, The University of Cincinnati Academic Health Center, Cincinnati, OH, USA.|Amway Corporation, Ada, MI, USA.
authors.forename: Sudhir
authors.identifier: http://orcid.org/0000-0003-4828-6856
authors.initials: S
authors.lastname: Baswan
authors.affiliation: James L. Winkle College of Pharmacy, The University of Cincinnati Academic Health Center, Cincinnati, OH, USA.
authors.forename: Gerald B
authors.identifier: http://orcid.org/0000-0002-4045-6868
authors.initials: GB
authors.lastname: Kasting
authors.affiliation: James L. Winkle College of Pharmacy, The University of Cincinnati Academic Health Center, Cincinnati, OH, USA.
authors.forename: S Kevin
authors.identifier: http://orcid.org/0000-0001-8626-9630
authors.initials: SK
authors.lastname: Li
authors.affiliation: James L. Winkle College of Pharmacy, The University of Cincinnati Academic Health Center, Cincinnati, OH, USA.
authors.forename: Randy
authors.initials: R
authors.lastname: Wickett
authors.affiliation: Department of Dermatology, College of Medicine, The University of Cincinnati Academic Health Center, Cincinnati, OH, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Adams
authors.affiliation: Amway Corporation, Ada, MI, USA.
authors.forename: Sean
authors.initials: S
authors.lastname: Eurich
authors.affiliation: Amway Corporation, Ada, MI, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Schamper
mesh_terms: D000287:Administration, Topical; D000935:Antifungal Agents / Q000008:administration & dosage / Q000493:pharmacokinetics* / Q000627:therapeutic use; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008855:Microscopy, Electron, Scanning; D009262:Nails / Q000737:chemistry / Q000378:metabolism* / Q000473:pathology / Q000648:ultrastructure*; D014009:Onychomycosis / Q000188:drug therapy* / Q000378:metabolism / Q000382:microbiology / Q000473:pathology; D010539:Permeability
chemical_list: D000935:Antifungal Agents
keywords: anti-fungal; iontophoresis; keratin; laser treatment; nails; onychomycosis