If self-care strategies and over-the-counter (nonprescription) products haven't helped, your doctor may suggest a combination of prescription drugs and other approaches. But even if you find relief from your signs and symptoms, repeat infections are common.
Oral antifungal drugs. Your doctor may prescribe an oral antifungal drug. Studies show the most effective treatments are terbinafine (Lamisil) and itraconazole (Sporanox). These drugs help a new nail grow free of infection, slowly replacing the infected part.
You typically take this type of drug 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.
Treatment success rates with these drugs appear to be lower in adults over age 65. And treatment success seems to improve when you combine oral and topical antifungal therapies.
Oral antifungal drugs may cause side effects ranging from skin rash to liver damage. You may need occasional blood tests to check on how you're doing with these types of drugs. Doctors may not recommend them for people with liver disease or congestive heart failure or those taking certain medications.
- Medicated nail polish. Your doctor may 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. You may need to use this type of nail polish daily for a year.
Medicated nail cream. Your doctor may prescribe an antifungal cream, which you rub into your infected nails after soaking. These creams may work better if you first thin the nails. This helps the medication get through the hard nail surface to the underlying fungus.
To thin nails, you apply an over-the-counter (nonprescription) lotion containing urea. Or your doctor may thin the surface of the nail (debride) with a file or other tool.
Surgical or other procedures
July 26, 2014
- Nail removal. 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. But 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.
Laser and light-based therapies. More study is needed, but these methods — alone or with medications — may help your nails improve. One study tested the effectiveness of carbon-dioxide laser therapy combined with antifungal nail cream. Most of the 24 people in the study benefited from the treatment.
Laser and light-based therapies are not available everywhere, are expensive, and often are not covered by insurance.
- Onychomycosis. The Merck Manual for Health Care Professionals. http://www.merck.com/mmpe/sec10/ch125/ch125c.html?qt=nail%20fungus&alt=sh. Accessed March 27, 2014.
- Goldstein AO, et al. Onychomycosis. http://www.uptodate.com/home. Accessed March 27, 2014.
- Toenail fungus. American Podiatric Medical Association. http://www.apma.org/Learn/FootHealth.cfm?ItemNumber=1523. Accessed March 27, 2014.
- Baran R. The nail in the elderly. Clinics in Dermatology. 2011;29:54.
- Varade RS, et al. Cutaneous fungal infections in the elderly. Clinics in Geriatric Medicine. 2013;29:461.
- Ferri FF. Ferri's Clinical Advisor 2014: 5 Books in 1. Philadelphia, Pa: Mosby Elsevier; 2014. https://www.clinicalkey.com. Accessed March 27, 2014.
- Gunduz T, et al. Epidemiological profile of onychomycosis in the elderly living in the nursing homes. European Geriatric Medicine. In press. Accessed March 27, 2014.
- Gupta AK, et al. Improved efficacy in onychomycosis therapy. Clinics in Dermatology. 2013;31:555.
- Westerberg DP, et al. Onychomycosis: Current trends in diagnosis and treatment. American Family Physician. 2013;88:762.
- AskMayoExpert. Fungal nail infection (onychomycosis). Rochester, Minn: Mayo Foundation for Medical Education and Research; 2013.
- de Berker D. Fungal nail disease. New England Journal of Medicine. 2009;360:2108.
- Lim EH, et al. Toenail onychomycosis treated with a fractional carbon-dioxide laser and topical antifungal cream. Journal of the American Academy of Dermatology. In press. Accessed March 31, 2014.