Fungal Nails (cont.)

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How is nail fungus treated?

Keeping nails trimmed and filed can help to reduce that amount of fungus in the nails and is highly recommended. A podiatrist or dermatologist may shave the top layer of the nail off or even remove part of the nail.

Creams and other topical medications have traditionally been less effective against nail fungus that oral medications. This is because nails are too hard for external applications to penetrate. A medicated nail lacquer, ciclopirox (Penlac) topical solution 8%, has been approved to treat finger or toenail fungus that does not involve the white portion of the nail (lunula) in people with normal immune systems. It only works about 7% of the time. There is some evidence that using an antifungal nail lacquer containing amorlfine can prevent reinfection after a cure, with a success rate of about 70%.

Efinaconazole (Jublia) is a medication approved in 2014. It is a topical (applied to the skin) antifungal used for the local treatment of fungal infections of the toenails. Daily application is required for 48 weeks.

Tavaborole (Kerydin) is another new medication that is indicated for onychomycosis of the toenails due to Trichophyton rubrum or Trichophyton mentagrophytes. Daily use for 48 weeks is also required.

Oral antifungal therapy works about 50% of the time. It can take nine to 12 months to see if it has worked or not, because that is how long it takes for the nail to grow out. Even when therapy works, the fungus may come back about 20%-50% of the time.

Oral medications that are effective against nail fungus include:

  • Griseofulvin (Fulvicin, Gifulvin, Gris-Peg): This drug has been the mainstay of oral antifungal therapy for many years. Although this drug is safe, it is not very effective against toenail fungus. Newer agents have largely supplanted it.
  • Terbinafine (Lamisil): This drug is taken daily for 12 weeks. The drug is safe, effective, and produces few side effects. However, it must be used with caution in patients with liver disease.
  • Itraconazole (Sporanox): This is often prescribed in "pulse doses" -- one week per month for two or three months. It can interact with some commonly used drugs such as the antibiotic erythromycin or certain asthma medications.
  • Fluconazole (Diflucan): This drug may be given once a week for several months. The dosing of this drug may need to be modified if the patient has impaired kidney function or is taking it simultaneously with certain other medications. It is not as effective as Lamisil or Sporanox and should be used cautiously in patients with liver disease.

There are several innovative treatments that are still being tested:

  • Photodynamic therapy uses application of light-activated agents onto the nail followed by shining light of a proper wavelength on the nail.
  • Use of electrical current to help absorption of topical antifungal medications into the nail
  • Use of a special nail lacquer that changes the micro-climate of the nail to make it inhospitable for the fungus to grow. If this works, it may be an inexpensive way to treat this problem in the future.

Vinegar is a commonly recommended home remedy. Its effectiveness is highly doubtful. Some people apply various oils and other tonics to their nails as well.

Medically Reviewed by a Doctor on 3/16/2015

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Fungal Nails - Treatments Question: What treatment did you use for your fungal nails?
Fungal Nails - Signs and Symptoms Question: What did your nails look like when you had a nail fungus? What were your signs and symptoms?
Fungal Nails - Prevention Question: If you've had a toenail fungus, how do you try to prevent it from recurring?
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