How do I get rid of nail fungus?

The most effective treatments for a fungal infection of the nail (onychomycosis) include oral antifungal medicines you take by mouth or prescription topical medicines you put on the nail and surrounding skin. In some cases, your doctor may decide to combine oral and topical treatments.

• Common antifungal treatments for nail fungus include prescription oral terbinafine (Lamisil), oral itraconazole (Sporanox), topical efinaconazole (Jublia), topical tavaborole (Kerydin), and topical ciclopirox (Ciclodan, Penlac Nail Laquer).
• Over-the-counter (OTC) products are available to treat fungus on the skin around the nail bed, but they do not work to treat the hard nail bed.
• Your doctor may recommend surgery to temporarily or permanently remove the nail as another option in more severe or resistant cases.

Treatment for fungus of the nail can take months, but not all people with nail fungus need to be treated. While the nail fungus may not go away, in many people it may not cause any long-term effects.

Fungal nail infections occur most frequently in the toenails, but can occur on the fingernails, too. Infections are most often caused by dermatophytes, yeasts, or molds. Sometimes, psoriasis can look like nail fungus, so you may want to have your doctor look at it closely for a correct diagnosis.

Nails with fungus usually turn thick and brittle, and may turn white, brown, black or yellow in color. Your doctor can diagnose nail fungus with an exam and may take a clipping or scraping of your nail for laboratory examination.

People with diabetes or who have trouble fighting infections (immunocompromised) may have an increased risk of getting other types of infections if they have nail fungus. See a doctor if you have diabetes or are immunocompromised and think you're developing fungus in your nails.

Patients with diabetes can develop a bacterial skin infection (cellulitis) and may have been told not to trim their own nails. If this is the case, see a healthcare provider for nail trimmings.

Treatment for nail fungus

Treatment can take several months with prescription oral medicine and up to a year with topical products. Repeat nail fungus infections are common.

Prescription treatments

Prescription medicines commonly used to treat nail fungus (onychomycosis) include oral and topical treatments:

• oral terbinafine (Lamisil)
• oral itraconazole (Sporanox)
• topical efinaconazole (Jublia)
• topical tavaborole (Kerydin)
• topical ciclopirox (Ciclodan, Penlac Nail Laquer)

Oral medicines

Oral antifungal medicines may need to be taken for 6 to 12 weeks and have a higher cure rate than topical treatments. They work by allowing a fungus-free nail to grow over the old one. Because they work faster, you and your doctor may prefer use of an oral agent when possible. If you cannot use an oral medicine or do not want to take systemic therapy, topical treatment may be an option.

Oral medicine for nail fungus infections may cause problems with your liver and may also have dangerous drug interactions. If you are taking oral antifungal medication, you may need to have regular lab tests to check on your liver. Always have your doctor or pharmacist check for any drug interactions with your prescription medicines, and over-the-counter, herbal supplement or vitamin products.

Topical medicines

Topical efinaconazole (Jublia) and topical tavaborole (Kerydin) are only approved to be used on the toenails. Topical ciclopirox (Ciclodan, Penlac Nail Laquer) is used to treat fungal infections of the toenails and the fingernails. These topical treatments are typically used for 48 weeks.

Side effects from topical medications are usually mild and may include redness, swelling, ingrown toenail, or stinging upon application. Most patients can tolerate these minor side effects.

Other options

Laser treatment and photodynamic therapy (PDT) are other options that may have some success for nail fungus. Speak with your dermatologist or podiatrist about these techniques.

Over-the-counter products

Several over-the-counter (OTC) products are available for nail fungus, but they do not work very well. Prescription products are usually more effective for nail fungus.

• Clotrimazole (FingiCure Intensive), tolnaftate (Fungi-Nail, Opti-Nail), and undecylenic acid are active ingredients found in over-the-counter products in the U.S.
• These products are used to treat the fungus on the skin around the nail bed and not for the actual nail itself, as noted on the package.
• Urea (Kerasol) can help to soften and improve the appearance of brittle, yellow nails, but is not used to treat the nail fungus.

Athlete’s foot (tinea pedis), a fungal infection in the areas between your toes and on the skin of your feet can lead to nail fungus or cause it to return. Be sure to treat your athlete’s foot with an appropriate antifungal medicine. Many effective products for athlete's foot are available over-the-counter or with a prescription.