Biofilms and the Nail Unit.

Recent studies have shown that a superficial fungal infection such as onychomycosis may form complex biofilms. Although most individuals susceptible to documented fungal biofilm infections are immunocompromised, physical damage to the nail or concurrent infection with other organisms is also a common risk factor in developing nail biofilm. The complex nature of the biofilm, which includes efflux pumps and the formation of a virulent extracellular matrix, helps it evade the immune system. Although there is no standardized treatment for fungal biofilms in onychomycosis, various studies using antimicrobials and lasers have shown some efficacy in treating human fingernails.