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Treatments and drugs
By Mayo Clinic staffNail fungus can be difficult to treat, and repeat infections are common. Over-the-counter antifungal nail creams and ointments are available, but they aren't very effective. If you have athlete's foot as well as nail fungus, you should treat the athlete's foot with topical medication and keep your feet clean and dry.
Oral medications
To treat nail fungus, your doctor may prescribe an oral antifungal medication. Studies have shown the most effective treatments to be terbinafine (Lamisil) and itraconazole (Sporanox).
Your doctor is likely to recommend oral medication if you:
- Have diabetes or other risk factors for cellulitis
- Have a history of cellulitis
- Are experiencing pain or discomfort from your nail infection
These medications help a new nail grow free of infection, slowly replacing the infected portion of your nail. You typically take these medications for six to 12 weeks, but you won't see the end result of treatment until the nail grows back completely. It may take four months or longer to eliminate an infection. Recurrent infections are possible, especially if you continue to expose your nails to warm, moist conditions.
Antifungal drugs may cause side effects ranging from skin rashes to liver damage. Doctors may not recommend them for people with liver disease or congestive heart failure or for those taking certain medications.
Other treatment options
Your doctor may also suggest these nail fungus treatments:
- Antifungal lacquer. If you have a mild to moderate infection of nail fungus, your doctor may prefer to prescribe an antifungal nail polish called ciclopirox (Penlac). You paint it on your infected nails and surrounding skin once a day. After seven days, you wipe the piled-on layers clean with alcohol and begin fresh applications. Daily use of Penlac for about one year has been shown to help clear up some nail fungal infections.
- Topical medications. Your doctor may also opt for other topical antifungal medications. You may be advised to use these creams with an over-the-counter lotion containing urea to help speed up absorption. Topical medications usually don't cure nail fungus, but they may be used with oral medications. Your doctor may file the surface of your nail (debridement) to lessen the amount of infected nail to treat and possibly make the topical medication more effective.
- Surgery. If your nail infection is severe or extremely painful, your doctor may suggest removing your nail. A new nail will usually grow in its place, though it will come in slowly and may take as long as a year to grow back completely. Sometimes surgery is used in combination with ciclopirox to treat the nail bed.
Treating nail fungus with a laser or photodynamic therapy — intense light irradiates the nail after it's been treated with an acid — may also be successful. However, this new treatment may not be available everywhere.
- Onychomycosis. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/sec10/ch125/ch125c.html?qt=nail%20fungus&alt=sh. Accessed May 5, 2011.
- Goldstein AO, et al. Onychomycosis. http://www.uptodate.com/home/index.html. Accessed April 21, 2011.
- Nail problems. American Podiatric Medical Association. http://www.apma.org/MainMenu/Foot-Health/Foot-Health-Brochures-category/Learn-About-Your-Feet/Nail-Problems.aspx. Accessed May 5, 2011.
- Kelechi TJ, et al. Four Vs for foot care. Vaseline, vegetable shortening, vinegar and Vicks VapoRub. Advance for Nurse Practitioners. 2004;12:67.
- Derby R, et al. Novel treatment of onychomycosis using over-the-counter mentholated ointment: A clinical case series. Journal of the American Board of Family Medicine. 2011;24:69.
- Habif TP. Nail diseases. In: Habif TP. Clinical Dermatology: A Color Guide to Diagnosis and Therapy. 5th ed. Edinburgh, U.K.; New York, N.Y.: Mosby Elsevier; 2010. http://www.mdconsult.com/books/about.do? about=true&eid=4-u1.0-B978-0-7234-3541-9..X0001-6--TOP&isbn=978-0-7234-3541-9&uniqId=230100505-57. Accessed April 21, 2011.
- Hay RJ, et al. Onychomycosis: A proposed revision of the clinical classification. Journal of the American Academy of Dermatology. 2011. In press. http://www.sciencedirect.com/science?_ob=ArticleListURL&_method=list&_ArticleListID=1761598027&_sort=r&_st=13&view=c&_acct=C000010878&_version=1&_urlVersion=0&_userid=130561&md5=e8df8bcde3b532684246542bf6609d1a&searchtype=a. Accessed May 5, 2011.
- Baran R. The nail in the elderly. Clinics in Dermatology. 2011;29:54.
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