Top Nail Fungus Treatments Rated for 2015

Learn which treatments can cure nail fungus safely at little to no cost, which prescription medication can cause liver damage and simple at home remedies some people swear by.


Which Treatments Work For Nail Fungus Infections?

Fungal infection of the nails (nail fungus) medically known as Onychomycosis, is a very common condition especially in the toenails. For most people, nail fungus is not a health risk, but more of a cosmetic problem. However If you are diabetic, have poor circulation and/or a weakened immune system, nail fungus can become a very serious problem.

It is imperative to treat nail fungus quickly once an infection starts.

Most nail infections are caused by dermatophytes, called that because they only infect the skin (or dermis) and skin structures like nails. Trichophyton rubrum and Trichophyton mentagrophytes cause most of the infection, with T. rubrum responsible for as many as 90% of onychomycosis cases. Candida (yeast) as well as certain molds can also infect nails.


Diagram of Toenail Fungus

How to Treat Nail Fungus

There are a number of ways to deal with onychomycosis. They almost always include cutting away as much of the affected nails first. These include:

The top 3 natural nail fungus treatments ranked as per effectiveness: (Click each link to read full reviews and product details)

No.1 Rated: Zetaclear – Learn More Here

No.2 Rated: Funginix – Learn More Here

No.3 Rated: Purnail – Learn More Here

With the right treatment, you should be able to get rid of a nail infection caused by fungus, even if you’ve had it for years or it’s very bad. But you may have to be patient. It could take months to clear up.

Key points about treating fungal nail infections

  • To get rid of a fungal nail infection, you will probably have to take a treatment, sometimes for up to six months.
  • Fingernail infections tend to clear up quicker than toenail infections. You may need to take medication for only six weeks for a fingernail infection.
  • Some Prespcription Medication can sometimes damage your liver (though this is rare) and you may have a test to check if your liver is healthy before starting a nail fungus treatment.
  • Normally doctors recommend pills for this condition, but there are also treatments you can put on an infected nail. If the problem is mild, you might be given a nail varnish or use tea tree oil that kills the fungal infection.
  • If your infection is severe or keeps coming back, your doctor might recommend removing part or all of your nail. But this treatment is rarely used.
  • If your nail infection doesn’t bother you, you may wish to leave it alone.


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Nail Fungus Treatments – What Everybody Ought to Know

By: Susan Miller MS BSN RN

Nail fungus, otherwise known as Onychomycosis, has been recognized as being a very difficult type of fungal infection to treat. It is a cosmetic condition that most often affects the toenails. Risk factors for nail fungus include increased age, male gender, diabetes, nail trauma, hyperhydrosis, peripheral vascular disease, athlete’s foot, immunodeficiency, poor hygiene, and chronic exposure of the nails to water. There are many species of fungus that can infect the nail. Often in nail infections several types of fungus will be present at the same time. All nail fungus infections result in thickened, discolored, and distorted nails.


In the past, treatment options were limited and often not very effective. Now there are several treatment options available to cure nail fungus. It is important to see your health care provider to ensure that it is truly a fungal infection you are dealing with before any treatment starts. There are other disorders (such as: Psoriasis, Lichen planus, contact dermatitis, and certain bacterial infections) that can cause similar looking nail problems. Your doctor can verify if it is indeed a fungal infection by examining nail scrapings and clippings under a microscope and submitting these samples to a lab to be cultured.

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The Science Behind Topical Toenail Fungus Treatments

In this article you will learn how topically applied treatments are used to treat nail fungus:


1. The anatomy of the human nail
2. The organism behind nail fungus
3. How topical treatments work

1. The anatomy of the human nail


The skin is the largest organ in the body and its most important function is to provide a selectively permeable barrier to the outside environment. The outermost layer of skin is called the stratum corneum (SC), Latin for horned layer, which is a dynamic structure that functions to protect deep layers of the skin from infection and injury [1]. This layer is comprised of dense skin cells (15 layers deep) called corneocytes [2] that originate deep within the skin and migrate to the surface of the skin as they mature. Complete replacement of these cells in the epidermis takes approximately 1-2 weeks, as it takes about 24 hours to form a single layer of the SC. One of the most important structures of the SC is the nail, which is a flat, hardened covering at the tips of the fingers or toes that has evolved to function as a protectant for the tips of our digits. The nail covers and protects a part of the finger called the matrix (see below), which is a layer of skin under the nail from which all of the cells that become the nail arise [3].

Nail Structure

The nail itself is comprised of three main layers. From the outer structure in, they are the nail plate, the nail bed, and the nail matrix. The nail plate, also called the dorsal outer layer, is dense and hard, consisting of keratin [4]. The nail plate is a thin (0.25 -0.6mm for fingernails and up to 1.3mm for toenails), hard, yet slightly elastic, translucent, convex structure that is made up of approximately 25 layers of dead keratinized and flattened cells. These cells are tightly bound to one another via numerous intercellular links, membrane-coating granules and desmosomes, which are cell structures specialized for cell-to-cell adhesion [4].

The nail bed is the skin beneath the nail plate [5]. Like all skin, the nail bed is made of two types of tissues: deep dermis, (the living tissue fixed to the bone which includes capillaries and glands), and the superficial epidermis (the layer just beneath the nail plate, which moves forward with the plate). The epidermis is attached to the dermis by tiny longitudinal “grooves” known as matrix crests.

The nail matrix (sometimes called the matrix unguis, keratogenous membrane, or onychostroma) is the tissue that the nail protects [6]. This part of the nail bed rests beneath the nail and contains nerves, lymph and blood vessels. The matrix is responsible for producing cells that become the nail plate. The width and thickness of the nail plate is determined by the size, length, and thickness of the matrix, while the shape of the fingertip itself shows if the nail plate is flat, arched or hooked [6]. The nail matrix continuously produces nail. The matrix at the base of fingernails consists of the most rapidly dividing skin cells in the body, which grow four times faster than toenails at a rate of about 3mm a month. This tissue consists of rapidly proliferating skin cells that soon fill with the protein keratin. This is the protein that gives strength to the nail [7].

The nail-plate (corpus unguis) is the actual nail that we usually refer to as the “fingernail” or “toenail.” This part of the nail is made of a clear protein called keratin. Several layers of dead, flattened cells make the nail strong and able to protect the end of the finger, yet partially flexible. The nail-plate is comprised of dorsal, intermediate, and ventral layers. The dorsal outer layer is dense and hard, consisting of keratin. However, despite its hardness, this layer of the nail is only a few cells thick (approximately 0.5mm) [8]. The dorsal and ventral layers of the nail plate have the highest concentration of lipids in the nail, and affect penetrability of treatments (see below) [9]. In intermediate layer of the nail plate contains highly compressed, flattened cells, in comparison with the other two layers, which contain softer, less compressed cells [10].

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Can Baking Soda Cure Nail Fungus?

Eww, nail fungus! Who wants to have brittle, discolored nails that keep you from reaching out to shake someone’s hand or from wearing open toed shoes? To make matters worse, if you go to your doctor, he will likely hand you a powerful anti-fungal medication that you need to take for months. Not only does that medication have side effects, it is often unreliable, expensive, and not covered by insurance.

The good news is that you can heal your nail fungus cheaply and naturally without much effort. Baking soda is one of the most common substances in your house, but it is scientifically proven to stop the spread of nail fungus. This will help keep it to one finger or toe, and it will stay localized to just one place on the nail. Tea tree oil is another topical medication that has anti-fungal properties to kill off the bugs in your nail. Used together, these all natural remedies provide a safe, effective way to manage a nail fungus problem.

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Amorolfine and Onychomycosis (Nail Fungus)

Fungal infection of the nails, called onychomycosis, is very common but difficult to treat. There is still no guaranteed way to cure the infection, no matter what treatment is chosen, but there are a number of ways to improve the appearance of the nails, lessen the infection, and perhaps cure it in some people. While there is a lot of agreement between medical professionals who treat this all over the world, the same medicines are not always available in different countries.

The two types of medical treatment are topical, medication applied directly to the affected nail or nails, or oral, taking medicine by mouth so it will get to the nail via the bloodstream. Oral medications usually have to be taken for 12 weeks, and achieve a “cure” from 60% to 75% of the time. However, these drugs have side effects including the potential for liver damage. Recurrence is common, from 10% to 50% of the time. Recurrence may be less likely if topical medicine is used on the nails; using both oral and topical medication may also improve the chance of eliminating the infection.

Oral medications are not able to actually kill all the fungus in infected nails, even if they can in the laboratory. The same thing can be said about topical medications. One idea is to combine the two to kill as many fungi as possible. For toenails, this must always be done along with cutting off as much infected nail as possible.

There are no FDA approved over-the-counter treatments available in the United States. There are creams made to treat athlete’s foot (a fungal infection of the skin) that can be used on toenails with varying success. These included Lamisil® (terbinafine), Nizoral® (ketoconazole), Mycelex® (clotrimazole), and Naftin® (naftifine), which are available without a prescription as well as with a prescription. The prescription medications are usually stronger. There are a couple of choices of topical medications FDA approved for fungal infection of the nails in the United States. These include ciclopirox lacquer (Penlac®) and tolnaftate 1% solution (called Formula 3).

A medicine used in many other parts of the world for the last 20 years is called amorolfine (trade name Loceryl®). It seems to be as safe and effective, if not more so, than the topical medications approved for use here. However, it is not FDA approved, and cannot be acquired in the United States or Canada. There are studies of its effectiveness and safety available because it is in use in Europe, the UK, and other places such as Australia. It can be ordered from other parts of the world.

Amorolfine is a different class of antifungal medication than the other topical drugs. It is active against essentially all the main classes of fungus that infect nails. Fungi called dermatophytes (meaning they like skin and skin structures like nails) are the most common causes of the infection. There are a few other fungi and mold that can cause onychomycosis and amorolfine can kill or stop these from growing in a laboratory setting. It works by damaging the membrane around the fungal cells. This kills dermatophytes like Trichophyton rubrum, the most common fungus involved. However, it does not always kill all the fungus in nails because it is very hard for it to reach every area of infection.

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How to Use Topical Nail Fungus Treatments

Sometimes just using a topical nail fungus treatment isn’t quite enough. Nail fungus is a difficult condition to treat – even if you do break down, go to the doctor, and get high-powered prescription medications – and you need to try multiple approaches to find something that will work. The problem is that the fungus gets down underneath the nail, and the nail’s primary job is to protect the soft tissue underneath from the outside world. Unfortunately, this means it protects the fungus from the healing powers of just about everything that you try to throw at it.


If you want to get rid of your nail fungus, you are going to have to stay dedicated to the task and try as many different remedies as you can. Don’t give up too soon on something, though. It can take months to see any improvement in nail fungus, even with doctor prescribed treatments. With home remedies, you have to use the treatments consistently and loyally, even when it seems like it won’t work. Of course, your best course of action is to prevent nail fungus from the start.

Tips for Using Topical Nail Fungus Treatments

If you have a topical nail treatment for your nail fungus, you are ahead of the game, but you can do a few things to make that treatment even more effective than merely rubbing it on your nail and leaving it alone. Topical nail treatments need to penetrate the hard, brittle nail that the fungus has created. Unfortunately, nail is not absorbent, so if you have thick nails, that topical solution is just sitting on top of the nail and not attacking the fungus. For starters, keep your nails clean and dry at all times. Fungus and bacteria in general love a warm, wet environment. If you have sweaty feet, use an anti-fungal foot powder to keep your feet dry.

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PurNail Nail Fungus Remedy Review

PurNail Nail Fungus Remedy is an all-natural alternative to the more aggressive products on the market for treating nail fungus. Rather than taking a powerful anti-fungal by mouth, you can use this topical treatment to help rid yourself of the fungus that is growing under the nail. It will take some time for this treatment to work. though. The product estimates that you will need about a three to four month supply, but if you do not want to take prescription medication or they are not effective for you, then scrubbing on a topical treatment might be the solution that takes care of your embarrassing nail fungus.


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Dr. Pauls Piggy Paste Review – Does this work to clear up Nail Fungus?

Nail fungus is a fungal infection of one or more of the nails on the fingers or toes. These infections typically begin as a yellow or white spot underneath the tip of the fingernail or toenail, and then progress deeper into the nail. They can cause the nail to discolor, thicken, and even crumble at the edges. Fungal nail infections are often difficult to treat and may recur following successful treatment.

Many over the counter (i.e., non-prescription) anti-fungal treatment options are available, however some are not very effective at treating true nail fungal infections. Oral prescription medications, such as Lamisil and Sporanox, can be  an effective means of treating fungal nail infections as well as tea tree oil, but treatments can take as long as four months to fully work. Other treatment options include a prescription antifungal nail polish called Penlac, however this make take up to one year to show improvement. In addition, some topical medications may be used along with a prescription medication.

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Nail Fungus Sufferers: What Works and What Doesn’t?

Are you tired of suffering from stubborn and ugly nail infections? Do you long for letting your once beautiful toes see the sunlight again? Do you wonder what it’s going to take to get rid of the fungus?

Over the years we’ve had the opportunity to collect testimonials from people who left comments on, who have used different types of nail fungus remedies. After analyzing them, we’ve created some useful suggestions for those who want to eliminate nail fungus.

Of course, nothing is ever 100% guaranteed, but if we can learn from others with similar problems, we have a better chance of crossing off one more problem we have from the list that seems to accumulate many problems as we age.


How Doctors Heal Patients

In fact, I was thinking about doctors and how they learn. I know that if you ask any doctor who he or she learned the most from, they will say their patients. In the practice of medicine, a doctor who pays the most attention to the results that their patients are receiving, and makes appropriate adjustments is often the most successful – both with people and against disease.

Recognizing this feedback loop was very valuable, we started collecting reports on remedies from our readers and have been able to create some basic guidelines for anyone with nail fungus problems who wants to use these treatments to get clear nails again.

Guidelines From Our Readers about Nail Fungus Remedies

Remedies for nail fungus are plentiful. Lamisil, a prescription and over-the-counter medication, is often recommended by medical doctors; both general practitioners and dermatologists. Home remedies such as tea tree oil, hydrogen peroxide, vinegar, or even Vick’s Vapor Rub could work. Even Star Trek technology has hit the nail fungus scene and doctors may use laser to zap the fungus into infinity. All of these remedies have good possibility of being successful.


Whatever remedy you use, remember that it’s not enough to focus on the remedy itself. You still have to clean the nail – and do it right. And you still have to thoroughly wash your feet daily.

The treatments must reach the nail bed. The fungal infection starts at the nail bed, not on the nail itself. Nail beds are composed of a thick keratin layer and your remedy must penetrate this to get those fungi predators that are lurking below the surface, knowing that they are well out of your reach. Develop a fungi killer mentality, as if you will be relentless about any of their lives!

General foot care is imperative: always trim and file down your nails. Also, don’t hide your feet, as difficult as it may be. Keep your nails and toes well-ventilated. And as much as you want to paint your toenails, don’t do it. Healing will need the area to be undisturbed.

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Treating Nail Fungus with a Weakened Immune System

People suffering from a compromised immune system are naturally more likely to develop an infection, whether it is viral, bacterial, or fungal in nature. The concern for this issue is that without a strong immune response the infection can spread and progress to life threatening proportions.


A normally functioning immune system is typically capable of fighting an infection and controlling it, perhaps with the aid of a medication. At some point during a person’s lifetime they may experience a suppression of the immune system for one reason or another, which then allows the dormant fungus to become active causing health complications.

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From Toenails to Tumors: Itraconazole in the Treatment of Nail Fungus and Cancer

Itraconazole (also known as Sporanox®) is an anti-fungal triazole compound first approved by the FDA in 1992 for the treatment of systemic fungal infections1. Itraconazole is well tolerated and is broadly effective against multiple types of fungus, including Candida and Aspergillus species, Cryptococcus neoformans, and many others2. The anti-fungal activity of itraconazole is mediated through its inhibition of cytochrome P450, a critical metabolic enzyme. Cytochrome P450 is required for the processing of lanosterol, the compound from which ergosterol is derived. Ergosterol is an integral cell wall component specifically found in fungi. Disrupted lanosterol metabolism prevents ergosterol synthesis, which severely compromises fungal membrane and cell wall integrity and leads to cell death3.


Nail fungus (onychomycosis) is the most common affliction of the nails, characterized by abnormal nail color, texture, and thickness. Nail fungus is caused by an infection of one of several possible species of fungi, with humidity, improper footwear, nail trauma, genetic predisposition, and immunosuppression considered contributing factors4. Both continuous and pulse itraconazole treatment regimens have demonstrated efficacy against nail fungus. A clinical response can be observed after several months of systemic treatment with orally administered itraconazole in over 80% of patients. Long-term remissions are observed in the majority of patients, although a small percentage of patients that have been successfully treated do ultimately relapse. Factors affecting treatment outcome include the site of infection (fingernail vs. toenail) and the species underlying the infection5,6. The efficacy of itraconazole in achieving clinical response and long-term cures of nail fungus is likely attributable to its ability to be absorbed into the nail and remain there at therapeutic levels for at least 6 months after completion of treatment5,7.

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How to Treat Nail Fungus (Onychomycosis) 2012 Edition

Onychomycosis, the medical term for fungal infection of the nail, is a common problem that is very difficult to treat. The toenails are more often affected than the fingernails, and the big toe is affected the most. There is often fungal infection of the skin near the nails, which on the feet is called tinea pedis or athlete’s foot. Since this is an infection, it can spread from one nail to another, although that does not always happen.


Fungal infections of the toenails are much more common than infections of the fingernails. It has been estimated that anywhere between 2 and 14% of adults have onychomycosis, and as people age, they are also more likely to have the infection. It is more likely to occur to the nails of people under a number of circumstances, including those who have had:

  • Nail trauma
  • A depressed immune system, such as after chemotherapy, HIV infection, or certain immunosuppressant medications
  • Diabetes mellitus (as many as 26% of diabetics have onychomycosis)
  • Poor circulation in the legs and feet
  • Difficulty cutting their toenails correctly

Onychomycosis is not dangerous. The affected nails become thick and difficult to cut. People with affected toenails may experience discomfort. This is especially true for the big first toenail. The pressure of shoes on it can be painful. Affected nails can get caught on clothing. There is a definite cosmetic problem with onychomycosis, especially of the fingernails. Most people want to get rid of the infection and make the nails appear more normal.

Fortunately, there are a few good or guaranteed ways to treat onychomycosis and a few treatments to avoid. This is not for lack of trying. Medical doctors as well as homeopaths and people experiencing the problem have all tried many different ways to get rid of the fungus. While no one has found a perfect cure all,  there are a few treatments that are worth trying as the results are promising.

Most of the fungi that cause nail infections are called dermatophytes, meaning that they like to grow in the skin. Candida, commonly called yeast, can also cause onychomycosis.


The appearance of an involved nail depends on where the infection begins. Most of the time, fungus gets into the sides or end of the nail. This results in a thickened and yellowed nail with debris underneath that most people recognize as a fungal infection. It can also penetrate from straight above the nail, which causes a superficial white, powdery appearance. Fungus can get into the nail from where it begins, especially in people with depressed immune systems. In these cases the entire nail will grow out with fungus in it. The more of the nail that is involved, the harder it is to treat.

Diagnosis of Onychomycosis

Before starting any treatment for this condition, you want to make sure that you are diagnosed properly. Other things can look like onychomycosis, including but not limited to nail damage as well as the changes in nails seen in people with psoriasis. Ideally you should see a doctor, and the doctor should take a sample of the nail and the debris beneath to look at under a microscope and to send for culture. Sometimes the microscopic examination and culture have to be done twice to get a definite diagnosis. You should be positive of the fungal infection before you start on any oral medication, if that is what you decide to do.

If you want to try over-the-counter medication or home remedies first, if they aren’t dangerous, there is not much risk. However, since there are other conditions associated with abnormal nails, if you don’t see a doctor, you might be delaying the diagnosis of some other illness.

Treatment of Onychomycosis


All treatment of onychomycosis, whether traditional or alternative, in a doctor’s office or at home, using medicines or surgical techniques, is less successful than treatment of other fungal infections, for example, in the skin. The fungus seems to be quite successful at living in and around nails.

Before specific treatment of onychomycosis of the feet begins, there must be a general assessment of the feet. Tinea pedis or “athlete’s foot” should be treated with an antifungal cream. This can be obtained over the counter or as a prescription. Lamisil® (terbinafine), Nizoral® (ketoconazole), Mycelex® (clotrimazole), Naftin® (naftifine), Loprox® (ciclopirox olamine) and others, including generic formulations are all effective. Calluses should be smoothed and moisturizer applied to any dry, cracked skin. Toenails should be kept short.

The feet need to be kept dry. This means thoroughly drying feet and toes after bathing. Absorbent cotton socks should be worn and changed when wet.

If it is suspected that a common shower is the source of the infection, for example, at a college dormitory, flip flops or other sandals can be worn into the shower. The feet showed by washed thoroughly with soap, dried, and the above suggestions continued. Towels and bath mats must be washed frequently in warm water.

If family members have tinea pedis, they should also be treated.

Any treatable underlying problem, such as diabetes, needs to be controlled as well as possible.

Fungal fingernail infections are associated with different problems. There can be fungal infection of the skin of the hands, which should be treated. People with fungal fingernail infections often have wet hands a lot of the time. This can be work related or due to many activities at home, from doing the dishes to keeping the bathrooms clean. White cotton gloves can be worn under rubber gloves when cleaning.

If damage has been done to fingernails due to artificial nail application or other materials, it is possible that there is more than just a fungal infection present. It is harder to be sure of a diagnosis of onychomycosis of the fingernails than toenails. A visit to the doctor is probably a good idea.

Treatment by a Physician

Treatment must begin by making sure the hands and/or feet are being taken care of properly, as mentioned above. A primary care doctor, or podiatrist (foot specialist) or dermatologist (skin specialist) may be able to help with this, depending on what the person needs to have done, what the person expects, and what the experience of the physician is.

Usually in the case of fungal infection of the toenails, trimming and removing extra thick toenail material is the first thing that needs to be done. Sometimes the nails are so thick and hard that it is virtually impossible for a person to trim them at home. Doctors have special instruments that enable them to cut off more. Podiatrists have burrs, which are kind of like sanders and can file down the nails.

For some people, getting the nails trimmed and back to something like a normal size and shape may be all the treatment that is needed. They may just need regular visits to keep the nails trimmed. This is especially important for people with diabetes, poor circulation, and elderly people with bad vision. The feet and nails can become a source of serious bacterial infections if they are not taken care of.

There are no studies to show what the natural history of onychomycosis is. Does it always spread? It does not seem to cause any serious problems. So for some people, nail trimming and reassurance is all that is necessary.

All treatments attempt to kill the fungus and allow uninfected nail to grow out. It takes approximately 6 months for fingernails to completely regrow, 12 months for toenails to grow out, and 18 months for the great toenail to grow out. A person cannot know if the fungal infection has been cured for that amount of time.

Topical Medications

It seems reasonable to try to treat toenail infections with the same type of antifungal medications used on the skin. The only topical medicine approved for use in the United States is ciclopirox olamine 8% (Penlac) which is a lacquer. There are other medications available in other countries.
Penlac needs to be put on the surface of the entire nail and the skin around it every day. Once a week, it is removed along with debris and unattached nail.

Naftin, Lamisil, and Loprox creams may also be used for onychomycosis. There have only been small studies done using these creams. There are topical medications available in other countries that may at some point become available in the United States.

The use of urea cream may help any topical medication penetrate the nail. Urea can also dissolve the toenail.

There is very little chance of an actual cure with topical preparations. They must also be used for months to years. However, if a podiatrist or doctor can significantly trim and pare down the thickened nail, and topical treatment is used, the cosmetic result may be satisfactory for some people. Podiatrists may also drill a hole in the nail to allow medication to get underneath. This is not as painful as it sounds.

Topical treatment may be the only choice for anyone who cannot take oral medications for fungus.


As described above, trimming the nail and removing debris should be part of all onychomycosis treatment. It was believed that removal of a nail at the beginning of therapy, especially the big toenail, might increase the chance of a cure. This is no longer done routinely. It is only done when everything else fails and the nail is creating a significant problem because of its shape and size.

Oral Medication


At one time it was thought that oral medication might be the answer to the problem of onychomycosis. Getting anti-fungal medicine into the bloodstream would deliver it to the base of the nail, and under the nail, making sure to kill all the infection. However, oral medicines do not work as well as expected, and their side effect profile may make the cure worse than the disease. It depends on the severity of the fungal infection, other medical problems that underlie the condition, and the medication itself.

The most commonly used oral medication, and the treatment of choice for onychomycosis is terbenafine (Lamisil®). This medication has been proved to kill most of the fungal organisms that infect nails in the laboratory as well as in actual patients. The dose is 250 mg a day for six weeks to treat fingernails, and 12 to 16 weeks to treat toenails.

Common side effects of terbenafine therapy include headache, rash, and upset stomach. Serious side effects occur in less than 1% of patients, including severe rash and reduction in white blood cells. The most worrisome side effect is liver damage, which is usually mild and reversible. Liver abnormalities that are enough to cause symptoms only happen in approximately one out of 50,000 exposures, with complete liver failure much less common than that. However, anyone with liver disease cannot take terbenafine. Liver function tests should be done before beginning therapy. Many doctors repeat these tests after 4 to 6 weeks. About 3.4% of patients who take terbinafine stop the medication because of side effects.

Itraconazole (Sporonox®) is also used. 200 mg a day can be given for 12 weeks to treat a toenail infection. There is also “pulse therapy.” This means giving 200 mg twice a day for one week out of a month, for two months to treat fingernails and three months to treat toenails. 5% to 10% of patients develop nausea, vomiting and/or liver damage. Sporonox can also cause congestive heart failure; patients with existing heart failure cannot take it. In general, there are fewer side effects with pulse therapy than daily therapy. However, even with pulse therapy there can be liver damage bad enough to necessitate a liver transplant.

Fluconazole has also been used to treat onychomycosis. It only needs to be taken once a week, for a total of 3 months for fingernails or 6 months for toenails. It does not work as well as terbinafine or itraconazole.

Whether or not any of these treatments have cured the fungal infection is never known for many months, until the fingernails or toenails have grown out. Terbenafine had a higher cure rate than itraconazole. The outcome can be measured by appearance of the nail or absence of fungal elements. The “cure” rates have been measured as low as 50%, and as high as 80%. Even when the fungi are gone, the nail may not appear completely normal because of some other underlying problem or damage to the nail bed. There are also frequent relapses. The use of creams applied to the nails after oral therapy may help prevent relapse.

The cost of this treatment is high. It is estimated that the cost to cure onychomycosis with terbinafine is from $2,500 to $8,000. There is still a 30% chance of recurrence after a cure.

Alternative Treatments and Home Remedies


Considering the cost, side effects, and low success rate of prescription medication, looking for alternative treatments seems very reasonable. Some alternatives have been mentioned in terms of general care of the skin and nails.

One herbal remedy that seems to be very successful in treating onychomycosis is tea tree oil. Tea tree oil has been studied for a number of skin problems and is already available as a prescription medication for genital warts. Tea tree oil can kill the fungi that cause nail infections in the laboratory setting. There have been some small clinical trials of tea tree oil in treating nail fungus that show promise, although rigorous, large scientific studies have not been published.

In one trial, a combination of a known antifungal (butenafine hydrochloride) together with tea tree oil was used in a randomized, double-blind study in 60 patients with fungal infection of toenails. Treatment included the cream as well as clipping and removing as much toenail as possible, for 8 weeks. At 16 weeks, 80% of participants given the active ingredients were said to be cured, in that their symptoms were better and involved toenail removed. The placebo in this case was tea tree oil, which did not cure any patients. This is an example of a possible way tea tree oil might be used along with another local cream but not by itself.

Other home remedies have included soaking the nails in vinegar, or water with baking soda, strong tea, and bleach. Bleach application can be dangerous. The bleach would have to be diluted to avoid chemical burns. When these home remedies are used along with care of the nail, such as cutting it correctly and removing debris, they may improve the appearance of onychomycosis. Tea tree oil is a home remedy at the current time; it may become a prescribed medication in the future. Any promising home remedy can interest doctors and researchers enough to look into it further.

Tea tree oil taken orally is also considered an alternative treatment for onychomycosis, but there is little evidence at this time that drinking tea tree oil does anything to cure the fungal infection.

There are 2 alternative treatments whose active ingrediants contain tea tree oil, Zetaclear & Funginix.

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