The primary mode of transmission of tinea infections is direct contact with other persons or surface reservoirs. Upon contact, the dermatophytes attach to the keratinized cells, leading to thickening of the cells. Although infection remains localized, bacterial superinfections may develop.

The pathophysiology of onychomycosis depends on the clinical type. With the most common form of onychomycosis, distal lateral subungual, the fungus spreads from the plantar skin. The fungus invades the underside of the nail through the distal lateral nail bed, leading to inflammation of the area. In cases of white superficial onychomycosis, the fungus invades the surface of the nail plate directly and the nail bed and hyponychium are infected secondarily. Proximal subungual onychomycosis infections begin in the cuticle and the proximal nail fold, then penetrate the dorsum of the nail plate.

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