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Onychomycosis is a relatively common dermatologic presentation (Table 1). The incidence of the disease varies regionally and with age. Although in most cases the condition poses no significant long-term health risk, treatment is indicated. Affected nails can be cosmetically unsightly and may become painful and cause functional impairment. In some cases, such as among diabetic patients, treatment of onychomycosis is imperative. These patients typically are concurrently using other medications, so treatment must be selected to minimize or anticipate any adverse drug interactions.1 Clinicians may encounter three clinical types of onychomycosis2,3: Distal lateral subungual onychomycosis develops when the fungus enters via the lateral nail groove and distal subungual area. Superficial white onychomycosis is the result of infection via the dorsal surface of the nail plate. Proximal white subungual onychomycosis develops following infection of the undersurface of the proximal nail fold. Although rare in the general population, this presentation may be found in immunocompromised patients. The nail fold remains normal in this presentation. Inflammation may indicate chronic paronychia with secondary nail involvement. More than 90 percent of cases of onychomycosis are caused by dermatophytes.3 Although dermatology care providers may highly suspect onychomycosis based on the presentation of dystrophic, yellowed nails, many experts now urge the use of diagnostic cultures to confirm the diagnosis and potentially direct treatment. A common mimicker of onychomycosis is psoriatic nail disease, discussed in the sidebar on p. 4. management of Onychomycosis: A review