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Treatments and drugs
By Mayo Clinic staffNail fungus can be difficult to treat, and repeated 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
- Want treatment because the infection is unsightly
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 onto 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 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 provide a cure, but may be used in conjunction 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 photodynamic therapy, in which a laser is used to irradiate the nail after it's been treated with an acid, may also be successful.
- 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 June 30, 2009.
- Goldstein A, et al. Onychomycosis. http://www.uptodate.com/home/index.html. Accessed June 30, 2009.
- Nail problems. American Podiatric Medical Association. http://www.apma.org/MainMenu/Foot-Health/FootHealthBrochures/GeneralFootHealthBrochures/NailProblems.aspx. Accessed June 30, 2009.
- Watanabe D, et al. Successful treatment of toenail onychomycosis with photodynamic therapy. Archives of Dermatology. 2008;144:19.
- De Berker D. Fungal nail disease. The New England Journal of Medicine. 2009;360:2108.
- Hinojosa J, et al. Which antifungal is best for toenail onychomycosis? The Journal of Family Practice. 2007;56:581.
