Onychomycosis in Solid Organ Transplant Recipients

Onychomycosis is a chronic nail fungal infection that represents the most prevalent nail disorder encountered in clinical practice. If left untreated, it can lead to progressive nail dystrophy, localized pain and significant psychosocial impact. Management of onychomycosis is inherently challenging due to the need for prolonged therapies and a high rate of recurrence. Solid organ transplant recipients are particularly susceptible to onychomycosis due to lifelong immunosuppression. This population faces unique therapeutic challenges, including drug–drug interactions between anti-rejection therapies and systemic antifungal agents. These complexities are further exacerbated by the lack of standardized treatment guidelines for this demographic. This narrative review explores the epidemiology, aetiology, diagnosis and management of onychomycosis in solid organ transplant recipients. Emphasis is placed on the complexities of balancing effective antifungal therapy with immunosuppressive regimens, as well as the need for tailored treatment protocols to optimize outcomes in this vulnerable population.