Most people know the telltale signs of toenail fungus, but few are aware of the best ways to get rid of this wily infection.
The condition is more common as we age, with about half of adults over age 70 dealing with this unsightly problem.
Onychomycosis (the medical term for nail fungus) is notoriously difficult to treat—some people spend years, or even decades, trying to eradicate their thick, brittle and crumbly toenails that may have turned yellow or brown.
But some therapies are more effective than others. In fact, new research shows that even particularly stubborn toenail fungus can now be eliminated with few risks for side effects.
How the battle begins
The environment inside your shoes is ideal for fungus—warm, humid and dark. What’s more, the hard nail structure makes it difficult for topical drugs to penetrate effectively.
Your feet encounter fungus every day—in the shower (be it public or in your home)…in your gym locker room…at nail salons…or when going through airport security if you’re barefoot when you pull off your shoes. These are common ways to contract athlete’s foot.
Toenail fungus, however, more often results from repeated nail injuries, such as your toes hitting the inside of your shoes when walking or running…or banging your toe into a chair or other furniture. Such injuries weaken the nail bed, allowing fungus to invade the toenail. Long toenails and snug shoes make the toenails vulnerable to these injuries, so proper nail care, including keeping your toenails trimmed, and proper shoe fit are crucial.
Important: A fungal infection can spread from one toenail to another, and early treatment helps minimize this. People with diabetes, poor circulation or compromised immunity should seek medical advice for toenail fungus.
To give yourself the best odds of vanquishing toenail fungus, here are five options that you may not know about—use one or more of these methods…
Treatment #1: Vicks VapoRub. Dabbed onto the affected toenail once or twice daily, this over-the-counter (OTC) topical cough suppressant often reduces—and sometimes cures—fungus in five to 16 months. It’s one of VapoRub’s “inactive” ingredients—thymol, a derivative of thyme used for its scent—that helps fight fungus. Other ingredients, including camphor, eucalyptus and menthol (all cough suppressants), may help combat fungus, too. You can apply it at night and then go to bed with or without socks.
Scientific evidence: When 18 adults with toenail fungus applied Vicks VapoRub daily for 48 weeks, the condition improved or was eliminated in 15 of the study participants, according to research published in Journal of the American Board of Family Medicine.
Treatment #2: Nail file and OTC topical antifungal. For an early-stage fungus called white superficial onychomycosis, topical medication applied to freshly trimmed nails may help. This fungus appears as tiny (a couple of millimeters in diameter) circular or oblong spots. Because it rests on top of the nail bed, rather than inside or underneath the nail, this infection may respond well to topical treatments.
What to do: File the nail as low as possible using a single-use emery board. This will remove some of the fungus-infected nail and deprive the remaining fungus of its preferred food source—the nail itself. Caution: Never dig under the nail with instruments. Doing so can loosen the nail from the nail bed, making it easier for fungus to enter.
Next, apply an OTC topical antifungal product containing tolnaftate, ciclopirox or one of the -azole medications (clotrimazole, miconazole or ketoconazole) daily. Although OTC antifungals marketed for athlete’s foot, such as Lotrimin AF (which contains clotrimazole), have only been FDA-approved for use on skin, they can be safely used off-label for onychomycosis.
Important: While the fungal-infected nail grows out, avoid nail polish for at least a few months. Conventional nail polishes act like paint, trapping and essentially protecting lingering fungus. In fact, many patients first notice white superficial onychomycosis at the end of the summer when they stop getting regular pedicures and there’s no polish hiding the spots.
If you do wear nail polish, choose a nontoxic formula that is free from chemicals such as formaldehyde and toluene. These versions are more “breathable” than traditional nail polishes, so they’re less apt to trap fungus underneath. For added protection, try a product (such as daniPro) that contains antifungal compounds to help prevent toenail fungus. Men, or women who wish to avoid color, can use a clear version.
Treatment #3: Lasers. With the power to vaporize and disable toenail fungus, lasers are one of the more effective treatments. As the nail grows, healthy nail should begin emerging from the base, indicating that the fungus is being killed. Lasers are painless, require no aftercare and improve the majority of cases. Laser treatment for toenail fungus, which is performed by a podiatrist, is typically administered once a month for at least three months.
Note: Laser therapy for onychomycosis is FDA-approved, but is not covered by insurance because it’s considered a cosmetic treatment. In some cases, the treatment may be covered if it’s medically necessary—for instance, if you have diabetes or are immuno-compromised. Ask your insurer. The fee varies widely—a course of treatment may cost up to $1,000.
Treatment #4: Oral antifungals. For patients whose onychomycosis is stubborn and affects more than half of the nail plate, oral antifungals may be the most effective option. For years, the standard protocol called for 250 mg of Lamisil, a costly prescription antifungal, once a day for 90 days. The treatment is effective in about 60% of cases, but side effects can include gastrointestinal upset, headache and liver toxicity. Liver damage occurs in less than 1% of patients who use the drug but is potentially fatal.
A new, safer option: A less expensive generic version of Lamisil, terbinafine hydrochloride, is now widely available and can be prescribed via an equally effective, more liver-friendly “pulse dosing regimen”—four cycles of 500 mg (two pills) daily for seven days each month (a total of 56 pills over four months). Pulse therapy was as effective at treating onychomycosis as the conventional daily regimen with the brand-name medication (typically one pill daily for three months), according to a 2019 study published in Journal of Fungi. Note: Most insurers only cover terbinafine, the generic medication, and not the brand-name version.
Treatment #5: Sanitized shoes. The fungus in your toenail is most likely living in your shoes. That’s why it’s smart to invest in an ultraviolet (UV) light shoe sanitizer. The Steri-Shoe Essential, for example, is a small device that you place in your shoes (closed-toed or even sandals) and plug in so that UV light can kill the fungi that can lead to toenail fungus. This product, which has the American Podiatric Medical Association Seal of Acceptance, sanitizes shoes and turns itself off in 45 minutes. It’s available online for $99.95. Even though it’s unlikely that socks will spread fungi when doing laundry, it’s best to wash socks in hot water and use bleach to be safe.