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What is toenail fungus?
Toenail fungus is also referred to as onychomycosis (your doctor may also refer to it as tinea unguium). Fungal infections can originate from a variety of molds, yeasts, and fungi that can grow in the cracks of the nail or skin surrounding the toenail. Athlete's foot, often contracted from locker room floors, is a type of fungus that can lead to an infected toenail or skin infection. The most typical fungus that grows on the feet and leads to needing treatment is called dermatophyte.
How is toenail fungus diagnosed?
Nearly 3 million people in the United States are diagnosed with toenail fungus each year. Men are up to three times more likely to develop toenail fungus than women. You are also at a higher risk for a toenail fungus infection if you smoke or have diabetes. Also, individuals with compromised immune systems may experience toenail fungus that can turn into an infection.
When feet remain moist or damp, the fungus can grow, causing discoloration and thickening of toenails. Infection can cause discomfort and pain. The spread of fungus and infection can go from toe to toe, hand, fingernails, or skin on other parts of the body.
The toenail may become warped, cracked, or loosen itself away from the nail bed. Often the nail appears yellowish and may have white spots. Your doctor will examine your feet and potentially take a small sample of skin or nail to be sent off to a laboratory for testing. Your doctor may refer you to a dermatologist, podiatrist, or other healthcare professional if your condition is unusual or needs special care. Other foot conditions such as psoriasis can look similar to a fungal infection. Lab reports can indicate if the problem is fungal, helping the doctor prescribe the best medication for effective treatment.
Toenail fungus treatment options
Treatment of onychomycosis will vary, depending on the severity of the infection and the type of fungus that initially triggered the infection. Topical treatments like antifungal creams and medicated nail lacquers are among the most effective treatment options for toenail fungus.
Laser treatment or the surgical removal of the toenail may be necessary in more severe cases of toenail fungus. Over-the-counter (OTC) products and home remedies are also methods used alone or in conjunction with prescription drugs to treat nail fungus and prevent reinfection.
Over-the-counter products to treat toenail fungus
Numerous over-the-counter (OTC) medications and products are available to prevent or stop the growth of toenail fungus. Products like OTC Lotrimin AF (containing the antifungal clotrimazole), Scholl Fungal Nail Treatment, and OTC Lamisil (containing the antifungal terbinafine) can be purchased without a prescription. While these medicines are useful in treating mild cases of foot fungus, they do not penetrate the cuticle or nail. Prescription medicine may be needed for more severe cases of toenail fungus.
Athlete's foot powders and sprays like Tinactin or Micatin can stop fungal growth before it develops deeper into the toenail. Treating the beginning stages of toenail fungus with OTC products can prevent complications associated with toenail fungus that is left untreated.
Toenail fungus medications
Prescription medications are often needed to treat toenail fungus that won’t go away with OTC medications or natural remedies. Your doctor may prescribe a topical antifungal cream or medicated nail lacquer to treat onychomycosis. Oral antifungal pills are another option for individuals suffering from toenail fungus.
Topical medication
Topical medications are fairly effective in treating mild to moderate toenail fungus. Topical solutions may include medicated nail lacquers, creams, or liquid medications. Loprox, Penlac, and Jublia are among some of the top medicines prescribed for toenail fungus.
Jublia
The medication, Jublia (efinaconazole), is an antifungal indicated for topical treatment of toenail fungus. Jublia is applied to the affected area once daily (for 48 weeks) with a brush applicator that comes with the prescription. Approved by the Food and Drug Administration (FDA), Jublia contains efinaconazole in a 10% topical solution.
Penlac
Penlac contains ciclopirox in an 8% topical solution. Available in generic as well as brand, it is applied once daily at bedtime to the affected nail and surrounding skin. It should be removed once a week with rubbing alcohol. Removal of the unattached, infected nail by a healthcare professional should be done frequently while on this medication, as often as once a month.
Oral medication
Internal medications taken orally are an alternative to topical medications used to treat toenail fungus. Sporanox (itraconazole) and Lamisil (terbinafine) are two examples of medications that can be taken orally to systemically treat onychomycosis.
Sporanox
Sporanox (itraconazole) is available in capsule form for treatment of onychomycosis. The capsule is to be swallowed whole and taken with a full meal. Be sure to consult your doctor or pharmacist and read all labels to be sure you know all of the risk factors and are taking the medication properly.
Lamisil
While Lamisil is often thought of as a topical OTC solution, it can be prescribed in an oral form as well. Prescription Lamisil may be taken for six (for the fingernail) to twelve (for the toenail) weeks or even more to see results of treating tinea. Ask your doctor about oral Lamisil if you have severe toenail fungus.
An important warning: oral antifungal medications have many drug interactions and can be very dangerous, or even fatal, if taken in combination with certain medications. For example, Sporanox can interact with the antibiotic Biaxin (clarithromycin), potentially causing an arrhythmia (irregular heartbeat). Review your medications with your doctor or pharmacist before taking an oral antifungal.
What is the best medication for toenail fungus?
Below is a list of the most recommended prescription treatment for toenail fungus.
| Best medications for toenail fungus | ||||
|---|---|---|---|---|
| Drug name | Drug class | Administration route | Standard dose | Side effects |
| Jublia (efinaconazole) | Antifungal | Topical | Once daily for 48 weeks | Itching, swelling, burning |
| Loprox (ciclopirox) | Antifungal | Topical | Apply cream twice daily for 4 weeks | Red, itchy, or burning skin |
| Penlac (ciclopirox) | Antifungal | Topical | Once daily before bed for up to 48 weeks (remove solution once weekly with alcohol) | Red, burning, or peeling skin |
| Nizoral (ketoconazole) | Antifungal | Topical or oral | Cream: 1-2x daily. Oral tablet: 200-400 mg once a day | Cream: irritation, itching, stinging. Oral: headache, dizziness, nausea, vomiting |
| Kerydin (tavaborole) | Antifungal | Topical | Once daily for 48 weeks | Swelling, itching |
| Sporanox (itraconazole) | Antifungal | Oral Capsule | 200 mg once daily for 12 consecutive weeks | Nausea, vomiting, rash, headache |
Dosage is determined by your doctor based on your medical condition, response to treatment, and age. Other possible side effects exist. This is not a complete list. A very rare side effect can be trouble breathing; if this occurs, seek immediate emergency medical attention.
What are common side effects of toenail fungus medication?
Topical medications often prescribed to treat toenail fungus can potentially irritate the skin. Itchy, peeling, red flesh and blisters may also occur with many topicals. Consult your doctor if your medication is causing an unwanted skin reaction.
Liver damage is one of the most concerning side effects of some toenail fungus medications. Due to the nature of onychomycosis, many of the medications need to be taken for long periods of time to completely resolve nail fungus. Gastrointestinal issues, dizziness, and trouble breathing are also listed as potential side effects. In addition, if the individual treating the toenail fungus suffers from heart conditions, the medication could interfere with heart health.
What is the best home remedy for toenail fungus?
Self-care and body awareness can be key in keeping toenail fungus at bay. Wash feet with warm soapy water and pat completely dry to reduce the spread or growth of fungus on the feet. Allow feet to breathe when possible. Protect your feet and wear breathable shoes and clean socks. Change socks regularly and wash in hot water if you are struggling with toenail fungus. Over-the-counter antifungal powders used for treating athlete's foot can also be used for treating mild cases of toenail fungus.
Avoid nail polish and pedicures that use polish or nail plate coatings. Even though you may want to conceal the discolored or warped look of an infected toenail, allowing maximum air circulation to the nail and skin of the toes is best.
Make an antifungal foot soak
Soaking your feet can also be a useful technique in reducing or eliminating toenail fungus. Many common household items can be used to make a healing antifungal foot bath. Mix one or more of the following with warm water and soak feet for 15 to 20 minutes. After foot bath, rinse feet with clean water and pat dry.
- Hydrogen peroxide
- Vinegar
- Baking soda
- Epsom salt
- Essential oils
Antifungal essential oils
Gaining popularity in homeopathic treatment, essential oils have antimicrobial and antifungal properties that may help to heal toenail fungus infections. Mix one or more of the following (use 2-3 drops) with a carrier oil like olive oil or coconut oil (use 20 drops) and apply to the affected area two to three times daily for several weeks.
- Tea tree oil
- Clove oil
- Clary sage oil
- Jasmine oil
- Lavender oil
- Ylang-ylang oil
- Eucalyptus oil
- Cinnamon oil
- Lemon oil
- Lemongrass oil
- Thieves oil (a blend of cinnamon, clove, eucalyptus, lemon, and rosemary essential oils)
Vicks VapoRub
Vicks VapoRub, or other mentholated salves containing the active ingredients menthol, eucalyptus oil, and camphor, are on the list of natural remedies for eliminating toenail fungus. This homeopathic remedy can be attempted alone or in conjunction with other treatments and medications. Clean and dry feet, and apply a small amount once daily.
Frequently asked questions about toenail fungus
What kills nail fungus fast?
Treating foot and toenail fungus before it becomes problematic is the best solution. Long-term regimens are often best to treat toenail fungus once it has developed deeper into the toenail.
Can Vicks cure toenail fungus?
Products like Vicks Vapor Rub contain the antifungal ingredients eucalyptus and camphor which can kill unwanted toenail fungus.
What causes fungus on toenails?
Yeast, molds, and fungus (like athlete's foot) can find your toe or toenail and begin to grow. Once the fungus establishes itself in the toenail, it needs to be treated to be removed.
Can toenail fungus go away on its own?
Unfortunately, toenail fungus will not go away on its own. If left untreated, toenail fungus will remain and spread. Untreated, you can develop an infection or lose your toenail.
Does hydrogen peroxide kill toenail fungus?
Yes, hydrogen peroxide does kill toenail fungus, although this method may need to be combined with other remedies to ensure all fungus is eliminated.