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Best Toenail Fungus Treatments According to Top Dermatologist

Fungal nail infections, also known as “onychomycosis,” are very common. It occurs in 10%-12% of the general population but becomes more common as we age. The prevalence is 20% in those older than 60 years and 50% in those older than 70 years. It is also most common on the big toenail.

A doctor scrutinizes a patient's foot.
Close-up of a man's toenail fungus.

What are the most effective antifungal medications for toenail fungus?

Toenail fungus treatments will vary depending on your symptoms. Your healthcare provider should look into multiple factors to help you to decide on the right treatment plan for you. It can be tailored to your individual needs. In general antifungal medicines are the most effective at curing and eliminating toenail fungal infections.

Treatments for toenail fungus break down into three categories:

1) Prescription treatments: these have the most evidence to support they work, as they need to go through large clinical studies to be approved by the FDA.

2) Over the counter medications: these are usually topical treatments that do not typically go through FDA review but many are believed to have an active ingredient that can inhibit fungus growth.

3) Homeopathic/home remedies: These are ingredients typically found in nature or their derivatives believed to prevent fungus growth which may work for Athlete's Foot but are unlikely to have much of an impact.

Prescription Treatments

Oral medications, or pills, typically work more quickly than topical treatments for toenail fungus. They also tend to have higher cure rates and may require a shorter overall treatment time. However, these oral medications require a prescription. It’s important to note that improvement can continue even after oral therapy is stopped, and it may take 9 to 12 months to see full results. Your healthcare provider will ensure that you are not taking any medications that could interact and will assess your medical conditions. Combining prescription oral medications with topical antifungals enhance treatment success, such as with our STRIDE DUO™ treatment, which boasts an impressive 89% clinical success rate.

The top treatments for toenail fungus are:

  • Terbinafine (Lamisil)
  • Itraconazole (Sporanox)

Terbinafine:

The best pill for toenail fungus is terbinafine. Evidence suggests it works better than the alternatives with the fewest side effects. Common side effects may include headaches, skin rash, and vomiting. It is taken once a day for 6-16 weeks.

Itraconazole:

Another good pill for toenail fungus is itraconazole. Side effects can include headaches, stomach upset, and respiratory infection. Itraconazole is also taken once a day for 6 to 12 weeks.

Other oral medications that are available to treat toenail fungus

Commonly used to treat yeast infections, oral fluconazole (Diflucan) is another pill sometimes used to treat fungus. Fluconazole is alternative to terbinafine and itraconazole for those patients that may not be able to take either of the other medications. Fluconazole is taken once a week for 12 months.

Morning photo of woman's feet on bed.
Close-up of a man's toenail fungus.

Topical Solution Prescription Treatments

Ciclopirox (Penlac Solution) is another topical medication used to treat fungal infections of the fingernails and toenails. It comes as a pale yellow solution supplied with a brush applicator and is applied once daily for 8- 12 months. Jublia (efinaconazole Solution) comes as a topical solution that is applied directly to the nail once daily for 48 week to the affected toenail fungus. Jublia is applied to affected toenails once daily using a flow through brush applicator and should be applied to the affected toenail once daily for 48 weeks. Jublia topical solution works similar to ciclopirox in that it stops the growth of the nail fungus.

Does Jublia work for toenail fungus?

In two clinical trials 17.8% (trial 1) and 15.2% (trial 2) of participants using Jublia were completely cured compared with 3.3% (trial 1) and 5.5% (trial 2) of participants using a placebo. The “complete cure or almost complete cure” rate for Jublia was 26.4% (trial 1) and 23.4% (trial 2) (compared with 7.0% (trial 1) and 7.5% (trial 2)).

How much does Jublia cost?

According to GoodRx, one 4ml bottle of Jublia costs $893.91 at CVS. Some patients may qualify for coupons or discounts from the manufacturer. 

Laser treatment options

Another option is a special laser beam to diagnose this infection. The FDA’s newest technology has been used to temporarily increase the clearness of nail fungi but has no cure. Laser treatments have a less favorable cure rate when compared with oral therapy. Your medical professional will rarely recommend a laser for nail infections.

Over the counter treatments

Treating nail fungus is not as easy as treating a yeast infection as the infection lives between the toenail and nail bed. This makes eliminating it more difficult because if you treat it topically, only some of the medication penetrates the toenail plate and the nail bed and often not enough to kill the fungus. Many over-the- counter treatments can be found in your local pharmacy but the data is limited on its actual success as they do not go through the same review process as FDA approved prescription treatments. Mild infections may benefit from such treatments.

Related: Why OTC Toenail Fungus Treatments Often Fail

Morning photo of woman's feet on bed.
Close-up of a man's toenail fungus.

Homeopathic Treatments

Similar to OTC treatments, there is limited data on success of homeopathic treatments. Some of the more common home remedies include the following:

  • Tea tree oil
  • Vicks VapoRub
  • Oregano oil
  • Lavender oil

Symptoms of Toenail Fungus

Toenail fungus often starts as a white or yellow spot on the tip of your toenail. As the fungi grow, they spread deeper into your nail, causing discoloration, thickening, and crumbling of the nail. The affected nail may also become misshapen or split.

If you have toenail fungus, you may notice one or more of the following symptoms:

  • White, yellow, or brown discoloration of your toenail
  • Thickening or crumbling of your toenail
  • Distortion of your toenail’s shape
  • Splitting of your toenail
  • Odorless debris building up under your toenail

If you notice any of these symptoms, it’s important to see a Healthcare professional that can diagnose and prescribe a treatment that is best for you.

Morning photo of woman's feet on bed.
Close-up of a man's toenail fungus.

How does someone get a fungal nail infection?

Anyone can get a fungal nail infection as it can be transmitted from contact with someone that has it or from the environment. Some people may be more likely than others to get a fungal nail infection, including older adults and people who have the following conditions:

  • A nail injury or foot deformity
  • Trauma/injury
  • Hyperhidrosis (a disorder that makes you sweat a lot)
  • Diabetes
  • Weakened immune system
  • Venous insufficiency (poor circulation in the legs) or peripheral arterial disease (narrowed arteries reduce blood flow to the arms or legs)
  • Fungal skin infections on other parts of the body, such as Athlete’s Foot

Can I wear nail polish if I have toenail fungus?

You could be trying to cover your discolored toenails with a polish. The issue is if you are using a topical prescription medication, this inhibits the medicine from working which is why this is not recommended by healthcare providers. Also because fungus thrives on damp surfaces, wearing nail polish can cause fungal infections to worsen.

What can happen if left untreated?

Aside from scaring small children or potential partners, the impact of toenail fungus largely depends on your overall health and immune system. For instance, if you have diabetes or a weakened immune system, toenail fungus can lead to complications like cellulitis, a skin infection that may escalate into a life-threatening condition. Pain is one of the most commonly reported symptoms of nail fungus.

About the Author: Neil Sadick, MD FAAD, FAACS, FACP, FACPH
Dr. Neil Sadick is known as one of the best dermatologists in the world. Author of more that 300 journal articles and over 20 books, he is one of the most influential people in Dermatology. Known as “the Doctor’s doctor” he travels the world training other dermatologists. All of this, along with Dr. Sadick’s research, has led to global innovation in Dermatology.

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