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Treatment of nail disorders

Bianca Maria Piraccini, Matilde Iorizzo, Angela Antonucci and Antonella Tosti

There are several reasons that make the nail unit difficult to treat. It is necessary to wait for several months before seeing the results of treatments in nail disorders, as the nail plate grows very slowly (average nail growth is 3 mm/month in fingernails and 1–1.5 mm/month in toenails). It is very important to give the patients this information, as they may otherwise discontinue the treatment feeling it to be ineffective. Delivery of topical drugs through the nail is difficult, as vehicles utilized for enhancing penetration of drugs through the skin are not effective in the nail. Most topical drugs are therefore ineffective in the treatment of inflammatory nail disorders, since the nails are largely exposed to environmental hazards and nail disorders are commonly precipitated or worsened by physical traumas. Thus, clinicians often do not prescribe systemic treatment when the disease is limited only to the nails.