Onychomycosis is a chronic fungal infection of the nail apparatus that remains challenging to treat due to the poor permeability of the nail plate, prolonged treatment courses, and high recurrence rates. Device-based modalities, including lasers, photodynamic therapy, plasma therapy, ultrasound, iontophoresis, and nail drilling, have emerged as potential adjunctive or alternative strategies to enhance therapeutic efficacy. While early studies suggest that these techniques may provide some clinical improvement and reduce fungal burden, the overall quality of evidence remains low. Nonetheless, device-based interventions represent a promising frontier in the management of onychomycosis.