Over the Counter Nail Fungus Treatments – Are There Any That Might Work?

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In the world of microorganisms, fungi are a pretty hardy bunch. There are generally harder to kill than bacteria and viruses. Dermatophytes, yeasts, and molds invade nails and dig themselves deep within the nail itself. Thus an already resilient organism is even further protected by layers and layers of keratin. Because of these reasons, treating onychomycoses has been difficult, historically. Even powerful oral antimycotic medications are not 100% effective. In light of this, can any over-the-counter nail fungus treatment be effective?

Fortunately there are a number of topical over-the-counter treatments that can effectively treat nail fungus infections. One over-the-counter topical onychomycosis drug that has been shown to be effective in a few clinical trials is amorolfine. Amorolfine is available without a prescription in the United Kingdom, New Zealand, and certain other countries. It is marketed under the brand name Loceryl. Amorolfine is distributed as a nail lacquer and the effective concentration is also the way in which it is sold, namely 5%. Amorolfine nail lacquer is painted on the nail, like polish, and then dries, leaving behind the drug. The drug is able to penetrate the nail and reach the site of the fungal infection. This drug penetration takes place over a week’s time.

Amorolfine is able to kill fungus by inhibiting with the cell membrane of the fungus. It can only be used on distal (or lateral) subungual onychomycosis and is ineffective on proximal subungual onychomycosis and superficial white onychomycosis. Therefore it is important to determine the correct type of onychomycosis.

It is unclear why amorolfine is not available in the United States, especially when it is available over-the-counter in other countries. The possible side effects are infrequent and mild when used as directed. Some patients report a burning sensation when they apply the lacquer at first, which goes away. With the advent of online pharmacies, it might be possible to purchase this medication from wholesalers or retailers based in other countries, but the cost may be prohibitive. Prices quoted for a single 5 ml tube of Loceryl can range as high as $100 or more.

A Natural Solution

One promising over-the-counter treatment for nail fungus is tea tree oil (Melaleuca alternifolia). Recent, small studies have shown that 100% concentrations of the oil may be able to cure 20% of those that use it and improve nail appearance in about two-thirds of patients. A 0.05 ounce bottle of the oil costs less than ten dollars.

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In head to head comparisons between twice daily application of 100% tea tree oil and 1% clotrimazole, tea tree oil may have been slightly more effective. Once such over-the-counter treatment that contains tea tree oil is Zetaclear.

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While Lamisil is available as a tablet and is a reasonably good oral onychomycosis treatment, the Lamisil that is available over-the-counter is a topical ointment or cream. While the topical Lamisil may do a good job at treating some fungal infections of the skin, like athlete’s foot, it is not terribly effective at treating nail fungus.

There are various over-the-counter nail fungus treatments that have not been rigorously tested in clinical trials. Therefore it is difficult to make any strong recommendations about them. One medicine that is sold as an anti-fungal nail liquid is undecylenic acid. There have been two papers published looking at undecylenic acid in the treatment of onychomycosis, one published in 1965 and the other in 2008. The 2008 paper shows a positive effect but undecylenic acid was combined with two other ingredients cyanoacrylate and hydroquinone. It is not clear whether this topical onychomycosis drug is effective on its own.

While clotrimazole (Lotrimin) is an over-the-counter fungus treatment, it is not effective at curing onychomycosis. Studies report a cure in less than 15% of those that use it to treat nail fungus. It may lead to an improvement in nail appearance but the disease is very likely to recur after treatment is stopped. Clotrimazole is better suited to other forms of tinea like jock itch (tinea cruris), athlete’s foot (tinea pedis), and ringworm (tinea corporis).

Tolnaftate (Tinactin) is another over-the-counter antifungal that is better suited to treat skin fungus. It is not effective in nail fungus treatment. Miconazole is sometimes found in over-the-counter fungal treatments but also suffers from being ineffective against nail fungus infections.

The statements made about these topical products assume that the affected nail has not been subjected to any surgical intervention. It is possible that surgical, mechanical, or chemical removal of the nail prior to over-the-counter nail fungus treatment may improve the effectiveness of the topical agent used. If you are considering surgery for onychomycosis treatment, ask your surgeon about nail fungus aftercare treatment options.

If you are not considering surgery for onychomycosis but are serious about getting rid of the nail fungus, the highest chance of success is through the use of oral antifungal agents. These nail fungus treatments are currently only available with a prescription.

References
Hammer KA, Carson CF, Riley TV. In vitro activity of Melaleuca alternifolia (tea tree) oil against dermatophytes and other filamentous fungi. J Antimicrob Chemother 2002;50:195-199.
Hart R, Bell-Syer SE, Crawford F, Torgerson DJ, Young P, Russell I. Systematic review of topical treatments for fungal infections of the skin and nails of the feet. BMJ 1999;319:79-82.
Rodgers P, Bassler M. Treating onychomycosis. Am Fam Physician 2001;63:663-668.
Turchetti B, Pinelli P, Buzzini P et al. In vitro antimycotic activity of some plant extracts towards yeast and yeast-like strains. Phytother Res 2005;19:44-49.

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60 thoughts on “Over the Counter Nail Fungus Treatments – Are There Any That Might Work?

  1. Based on hundreds of comments on this site, it’s clear that there are a variety of remedies. What works for one person is completely ineffective for another, and the difference is explained by the variety of infections.

    But that isn’t really the problem. The problem is getting the medicine to the affected area.

    Unless you are willing to go with an oral solution with it’s potential health risks, you must remove the nail, because it keeps the medicine from reaching the affected area.

    I found that prescription ciclopirox laquer not only costs 10x other topicals, but didn’t seem to penetrate the nail. No effect at all, except on my wallet.

    In frustration, I purchased 2 bottles of cicliopirox from eBay, $22 on eBay, which is 1/10 the price per unit of the prescription stuff and is water-based. I cut the nail and all dead material, very carefully, once a week, and for a year, applied the topicals as close as possible to the affected area. Problem solved.

    One guy in his comments on another page of this site suggested using a dremel tool, which would have been eaiser than nail clippers, but takes some guts.

    Steve, in this same thread, suggested on 08 Jan 2012) to use Salicylic acid to remove the nail. That seems a good idea.

    So, here is the best solution to the problem:

    1. Remove the nail to expose the infected area. See Steve from 08 Jan 2012 above for details.

    2. Apply home or over-the-counter remedy, and i it fails, try another & another. See DANMD from 17 Feb 2012 above for a list.

    3. Once problem is gone, do a weekly soak in vingear or over-the-counter remedy to reduce the likelihood of re-infection.

    Also, I find that wearing mostly cotton socks rather than those of various plastic threads (polyester, etc.) means my feet can breathe and the socks will soak up any sweat. That prevents excessive stink, and reduces fungus.

  2. I am using Vick’s rub and I got rid of the fungus on one big toe and the other three I have seen a big change in the sign of the fungus under the nail. It does work but it may take 6 months or more. I will keep it justntomkeep control ofbthenfungus from growing

  3. No Short Cuts Exist! It helps if you are OCD, Anal Retentive, or just plain Self-Disciplined. 3 months, every day TWICE. All thru Europe & US Tour. Drag the applicator brush across the end of the nail where it meets the nail bed (skin). Then cover nail liberally.. Wear sandals, go barefooted when possible. I even tried putting a condom over the freshly medicated toe, my wife objected. The longer the twice a day application remains undisturbed the better. I do not have the “courage” to Dremel my own toe, but saturation of nail to nail bed is important, hence, twice a day routine. I used “Fungi-Cure” I’m cured, and still OCD, Anal Retentive, & Self Disciplined..Be well. “cured” .

  4. Dr Christine says:

    I have tried lots and lots of over the counter products for years and years. The money I spent on Loceryl! then I started using stuff from the web, When my nails looked good and had grown out, after a month the rotten fungus would be starting to creep back again. Used a manuka cream with an “accelerator”. Held it in check a bit but big problemo… the fungus kept spreading to other fingers and toes. One toe or finger would start looking better and another one would suddenly get it. It was driving me mad. Now trying the pythium oilgandrum. So far so good. One more application to go with it. Will keep you posted. I had a really tough fungus.

  5. Dr Christine-

    “Now trying the pythium oilgandrum. So far so good. One more application to go with it. Will keep you posted. I had a really tough fungus.”

    How is this working? I have tinea versicolor, spots around my waist and abdomen.. was wondering if this would be affective cure?

    Thanks!

  6. I tried Piggy Paste for several months with hardly any improvement. I went to a podiatrist and he gave me a bottle of FFN r/x. after one week, I am truly amazed at the improvement. I am to see him in 8 weeks and I suspect the fungus will be completely gone by then.

  7. Vicks worked for me. Trouble is t will come back. Now taking FFN-RX. My dermatologist told me about Vicks and she was spot on.

  8. My dermatologist told me about Vicks and it worked. She said for whatever reason
    Fungus does not like Vicks. Only problem is it comes back. Now on
    FFN-RX which is going great.

  9. My doc gave me Spora…for 3 months, then switched to Lami… (actually Lami… should be the first line, don’t know y he gave me Spora) and using Loce..topical for the whole seven months. Culture found trichophyton species. 7 months getting only worse. When first discover, I used undecylenic 10% for 2 weeks, then apply Scho… lacquer. Microbiologist told me that there’s an antifungal can try called Voriconazole but very costly. I surf on the net saying that the success rate is lower than Spora and Lami. Now try soaking my foot in baking soda and epsom salt, rub chlorhexidine gluconate cream, taking antifungal supplement don’t know if all that works? anyone can share any success stories with home remedies?

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