Fungal nail infections can be difficult to cure, and they typically don’t go away without antifungal treatment and often recur with treatment. The best treatment for a fungal nail infection is usually prescription antifungal pills taken by mouth. In severe cases, a doctor might remove the nail completely. It can take several months to a year for the infection to go away.
Topical therapy requires longer treatment courses than oral tablets and may be less effective. For mild to moderate fungal nail infections, i.e.,involving ≤50 percent of the nail, either topical or oral tablets are options. Oral tablets are the treatment of choice for more severe disease, i.e., involving >50 percent of the nail.
You may prefer topical therapy if you:
- cannot take oral antifungal tablets
- take other medications that may cause a drug-drug interactions with oral antifungal tablets
- want to avoid oral treatment (especially with three or fewer nails involved)
Prescription topical antifungal drugs include one of the following medications for 4-6 months for fingernails or 12 - 18 months for toenails
Oral terbinafine is considered to be the first-line treatment for confirmed moderate-severe onychomycosis; the treatment course is generally 6 weeks for fingernails and 12 weeks for toenails.
Azoles (itraconazole, fluconazole, albaconazole, posaconazole, ravuconazole) can also be used but are less effective than terbinafine.
Procedures which treat fungal nail infections include:
- surgical debridement or removal of the affected nail
- photodynamic therapy shows promise in small studies
- laser treatment shows promise in small studies
Over the counter remedies which have shown limited effectiveness include:
- medicated chest rub containing eucalyptus oil, camphor, menthol, thymol, oil of turpentine, oil of nutmeg, and oil of cedar leaf (eg, Vicks VapoRub) x 48 weeks
- resin lacquer or amorolfine 5% lacquer once daily x 9 months
- nail polish containing acetic acid (vinegar) x 6 mo