Clinical Pharmacokinetics

, Volume 38, Issue 2, pp 95–110 | Cite as

Drugs in Nails

Physiology, Pharmacokinetics and Forensic Toxicology
  • Alessandro Palmeri
  • Simona Pichini
  • Roberta Pacifici
  • Piergiorgio Zuccaro
  • Annunziata Lopez
Leading Article


In recent years, drug analysis in keratinised matrices, such as hair and nails, has received considerable attention because of several advantages over drug testing methodologies employing body fluids, such as urine or serum. For example, keratinic matrices, such as finger- and toenails, can accumulate drugs during long term exposure. Drugs are incorporated into nails by a double mechanism: (i) deposition into the root of the growing nail via the blood flow in the nail matrix; and (ii) incorporation via the nail bed during growth from the lunula to the beginning of the free margin. Together, these account for a wide retrospective window of drug detection.

Nails can provide a good forensic matrix for the detection of drugs of abuse. Indeed, the international literature has reported the use of nail analysis in postmortem detection of drugs of abuse, drug testing in the workplace and drug screening to detect prenatal exposure, even though further studies are needed for correct interpretation of the data obtained.

Another application of drug analysis in nails consists of the possibility of detecting the presence of an antimycotic at the site of action during antifungal therapy for patients with onychomycosis. When available, this evidence has permitted drug treatment of a shorter duration and reduced toxicity However, so far the potential of drug monitoring in nails still lacks harmonisation and validation of analytical methodologies and a better comprehension of the possible correlation between drug concentrations in the matrix and period of exposure.


Cocaine Fluconazole Itraconazole Terbinafine Nail Plate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors acknowledge Dr Manuela Pellegrini and Dr Claudia Mortali for their help in the preparation of the manuscript.


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Copyright information

© Adis International Limited 2000

Authors and Affiliations

  • Alessandro Palmeri
    • 1
  • Simona Pichini
    • 1
  • Roberta Pacifici
    • 1
  • Piergiorgio Zuccaro
    • 1
  • Annunziata Lopez
    • 2
  1. 1.Clinical Biochemistry UnitIstituto Superiore di SanitàRomaItaly
  2. 2.Forensic ToxicologyUniversità degli studi ‘La Sapienza’RomeItaly

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