The route of rapid access of drugs to the distal nail plate

: It has recently been shown that antimycotic drugs have unexpectedly rapid access to distal nail, which we have suggested occurs through the site of continuous ventral nail formation along the nail bed. To exclude the alternative possibility of diffusion through the nail plate, we have measured the effect of topical terbinafine cream in onychomycosis. Sustained outward movement of the fungally affected distal segment was seen in only 2 of 10 measured nails, and there was no change in the mean severity of clinical involvement in 53 nails under study. This excludes significant diffusion of drugs through the nail plate, and we conclude that the route of rapid access is indeed through the nail bed.