Toenail Fungus medications & treatments

Medically reviewed by  Jamie Winn, PharmD

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Onychomycosis (tinea unguium) is the medical term for nail fungus. Fungal infections can develop from several molds, yeasts, and fungi that grow underneath the surface of the nails or the skin around them.

Nail fungus is quite prevalent, particularly among the elderly. Onychomycosis occurs in approximately ten percent of individuals worldwide, according to medical experts. This number increases to fifty percent of people older than 70.

What is toenail fungus?

Fungal nail infections are common fungal infections of the fingernails or toenails that can cause discoloration of the nail plate. The nails may also thicken, and be more prone to crack and break.

Athlete’s foot, which can be caught by walking barefoot on unclean floors in locker rooms or other places, can cause a skin infection, usually between the toes. Dermatophyte is the most typical type of fungus that attacks the feet and requires treatment. Athlete’s foot can lead to an infected nail, which can then spread to other healthy nails. It is, however, not common to catch this type of infection from someone else.

If your condition is minor and not bothersome, you may not require treatment. In severe cases that are causing pain and thickened nails, topical treatments, oral medications, as well as home remedies, might help. But even if therapy is effective, nail fungus frequently returns.

What are some risk factors for developing toenail fungus?

Toenail fungus can affect anyone, especially the elderly. Factors that put you at a higher risk include:

• Diabetes
• Age (risk increases with age)
• Weakened immune system
• Athlete’s foot
• Psoriasis
• Damaged nails
• Smoking
• Poor blood circulation
• Genetics
• Living in a hot, humid climate

How is toenail fungus diagnosed?

Your health care provider will examine your nails and surrounding skin to determine if you have nail fungus. Because the disease may spread, it’s critical to inspect the skin as well. You could already have a fungal infection, such as athlete’s foot, on your skin. All of the affected areas will need to be treated to get rid of the infection.

Your health care provider may take samples before giving you the diagnosis. Collecting a bit of debris from the nail bed, trimming off part of your nail, or scraping off some skin can be very useful. These specimens can be looked at under a microscope or sent off to a lab to identify the specific fungus causing the infection.

This is to make sure it’s a fungal infection and not another condition such as psoriasis, which can look very similar. This will also help your health care provider determine the best treatment options.

If your case is uncommon or requires particular attention, your doctor may recommend you to a dermatologist, podiatrist, or another healthcare expert.

What are some options to treat toenail fungus?

Toenail fungus is known as being very difficult to treat.  Depending on the severity of the infection and the type of fungus that caused it, treatment options will vary. There are over-the-counter as well as FDA-approved prescription options available.

Topical medications, including medicated nail lacquers and antifungal creams, are some of the most successful ways to cure mild cases of toenail fungus.

In severe cases, laser treatment or the removal of the infected nail may be required.

Are there over-the-counter (OTC) medications used to treat toenail fungus?

There are many OTC options to prevent and treat toenail fungus. Topical fungal creams such as Lamisil (terbinafine) and Lotrimin AF (clotrimazole) are some common products available. While very useful in treating athlete’s feet, they do not penetrate the nail or cuticle very well so it probably won’t be very helpful, unless it is started in the very early stages of the infection.

Udencylenic acid is another main ingredient in OTC products used to treat toenail fungus. It comes as a liquid or a nail polish you paint on your nails. As with the other topical OTC products, it does well to treat any fungus on the skin around the nail bed but not much with fungus on or under the nail itself.

What are some prescription toenail fungus medications?

The best products for toenail fungus treatment, especially in severe cases are oral antifungal drugs. For milder cases and for patients who cannot take oral antifungal drugs due to the side effects or drug interactions, there are also topical prescription nail polishes available.

Oral antifungal medications are more likely to work quickly to cure toenail fungus than topical medications. They also have a higher cure rate and the overall treatment time may be shorter. The top oral medications include:

• Lamisil (terbinafine)
• Sporanox (itraconazole)

While these tend to treat fungal infections better than topical products, they are also associated with more drug interactions and side effects such as nausea, vomiting, and headaches. More serious side effects such as liver damage may occur.

Topical medications are a different option and can be helpful in mild cases. These are painted or applied on the nail and aren’t very effective for severe cases. The most common topical medications include:

• Penlac (ciclopirox) 8% topical solution
• Jublia (efinaconazole) 10% topical solution

The side effects of these medications are usually mild and include itching and burning at the application site.

What is the best medication for toenail fungus management?

The best medication for toenail fungus will depend on the individual’s specific health problems, medical conditions, medications that the individual is already taking that may potentially interact with toenail fungus medications, and the individual’s potential response to the treatment. It is advisable to always speak with your healthcare provider about the best medication for you. The table below includes a medication list of some of the most prescribed toenail fungus medicines as well as common starting dosages and side effects.

Best medications for toenail fungus

Your healthcare professional will determine the dosage which is right for you based on your response to the treatment, medical condition, weight, and age. Other possible side effects may exist and this is not a complete list.

What are the most common side effects of toenail fungus medications?

The side effects of topical preparations are usually mild and include redness, burning, pain, and peeling at the application site.

The most common side effects of oral medications are stomach issues like nausea and diarrhea. Some other common side effects are headaches and rash. Oral medications can cause more serious side effects including liver damage. It is not common and can be reversed by stopping the medication. Your health care provider will test your liver function before starting treatment and periodically while taking the medication.

Can toenail fungus be treated naturally?

The best home remedy or natural treatment is good foot care and preventative measures such as:

• Keep your feet clean and dry
• Wear shower shoes in public pools and bathrooms
• Change shoes and socks daily
• Wear breathable shoes that fit correctly
• Clean your nail clippers before using
• Trim your nails straight across

Some other home remedies such as Vicks Vaporub and essential oils like tea tree oil do have some antifungal properties but there isn’t enough evidence to recommend their use.

Frequently asked questions about toenail fungus

What causes toenail fungus?

If you develop a fungal infection in your nail you can usually blame onychomycosis, a fungus, and yeast that loves dark, damp places, such as under the fingernails and toenails.

What is the quickest way to get rid of toenail fungus?

The earlier you get diagnosed and start treatment on the affected nail, the faster you can get rid of it. Leaving it untreated for some time will usually require long-term treatment.

Are fungal infections contagious?

A toenail fungus can be spread between close contacts. If someone you come into close contact with has a fungal infection, be careful not to share towels, socks, shoes, or nail care products.

Can toenail fungus go away without treatment?

No. Once the nail is infected, it must be treated. Left untreated, it can spread and cause you to lose your nail.

Related resources for toenail fungus

• Nail fungus overview. Mayoclinic.org
• Toenail fungus disease page. ClevelandClinic.org
• Nail fungus: diagnosis and treatment. American Academy of Dermatology Association
• Nail fungus: Overview. National Library of Medicine
• Fungal nail infections. Centers for Disease Control and Prevention
• OTC and home remedies for foot fungus. WebMD