Toenail fungus (the medical term is "onychomycosis") is a very common condition. You can get it from walking around a wet pool deck or locker room, or from sweating in shoes all day. Nail fungi love warm, moist environments. You'll know if you have toenail fungus from seeing white, brown, or yellow spots on your toenail. Over time, your nail might thicken and even start to lift from your toe.
Nail fungus doesn't go away by itself. And if you don't treat it, there's a chance it could get worse and cause pain when you walk. It could also spread to other nails or through your body.
Luckily, there are a number of ways to take care of it.
Prescription toenail fungus treatments
These include creams, sprays, and gels like ciclopirox (Penlac), efinaconazole (Jublia), and tavaborole (Kerydin). These are best for surface fungus, as the products don't penetrate your nail bed. It may take a year of daily use before you see the fungus go away. Your foot doctor (podiatrist) will likely trim your nail and file away its dead layers to help the product penetrate deeper into your nail. They may also take a piece of your nail and send it to the lab to make sure it’s really a fungus and to find out what type it is.
Antifungal pills like itraconazole (Sporanox) and terbinafine (Lamisil) work better than creams and gels. You usually take them for 12 weeks, but the fungus may not be completely gone for 10 months or longer. These pills have high rates of success, but terbinafine can affect your liver and itraconazole can interact negatively with other medications, so your doctor needs to monitor you while you take them. They also come with side effects like nausea, vomiting, and headaches.
Nail removal
If the infection is deep and you’ve had it for a while, your doctor may want to remove all or part of your nail. Your nail can be removed surgically or nonsurgically. For nonsurgical treatment, your doctor will put urea ointment on the infected nail surface and wrap the nail in plastic and tape. The ointment softens the nail bed. After about 10 days, the doctor can remove the infected nail from the nail bed, or just cut away the diseased part of the nail.
For surgical treatment, your doctor first gives you a shot so you don't feel pain. Then they will loosen the skin around your nail with a special tool and remove the nail from the toe. This procedure is rarely done.
A new nail usually grows back, but it might take a year or so. While it's coming back, your doctor will likely give you a cream or other treatment to put on your nail bed to keep fungus away.
OTC toenail fungus treatments
Antifungal creams, gels, sprays, and patches are available at drugstores or online without a prescription. These include clotrimazole (Lotrimin) and terbinafine (Lamisil). (You can buy terbinafine cream over the counter, but you need a prescription for the pills).
Over-the-counter (OTC) products are best for mild toenail fungus and may take months to work. While you're using them, file or cut off any white markings on your nails. Soak your nails in water and dry off before you put on the medicated cream.
It's important to note that most OTC products aren't strong enough to cure a moderate or severe case of toenail fungus. For that, you'll need prescription drugs.
Laser treatment for toenail fungus
Because of the possible side effects from pills, some people try laser treatment. There are different types of laser treatments, but in general, the laser heats up the nail layers where the fungus is and tries to destroy its genetic material. Treatments take about 30 minutes and are not covered by insurance. You usually need at least two treatments 5-6 weeks apart, and it will take about 2 months from the first treatment to see results.
Studies are mixed on how well laser treatment works. The American Academy of Dermatology says that although laser treatment sounds "promising," more research is needed to know whether it is safe and effective.
Antifungal nail polish
Your doctor might prescribe an antifungal medicine that you paint on your nails. This will look like a colorless nail polish and will contain a drug like ciclopirox. You'll get instructions on how often to use it, but usually, you paint it on the affected toenail once a day, every day. Let it dry for 30 seconds before putting on socks or shoes. Once a week, remove the polish with rubbing alcohol and as much of the diseased nail as you can, using clippers or scissors.
It may take 6 months or more before your nails start to look better. Studies show antifungal nail polish is much less effective than taking pills, so your doctor may pair the two remedies so you get a better outcome.
How to know if toenail fungus is dying
Your nails might still not look good while the fungus is clearing up, but one sign that the toenail fungus is dying is that you see a healthy nail growing back at the base of your toe, separate from the unhealthy nail. The healthy nail will be its natural color and not thick. Keep in mind that it may take 12 to 18 months for a toenail to grow out.
Be sure to finish any medication your doctor has prescribed for you. If you stop taking it when your toenail starts to look better, you might be allowing some hidden fungus to grow back. If you think your fungus has returned (you see changes in nail color or texture, or you get swelling or itching), see your doctor.
Toenail Fungus Home Remedies
Want to try natural remedies to remove your toenail fungus? Studies have shown mixed results. Here are some of the more popular suggestions:
Tea tree oil for nail fungus
This comes from distilling the leaves of the tea tree, a plant from Australia. It's been used traditionally as an antiseptic (to kill germs) and researched for use on other skin conditions like acne.
In one study, tea tree oil was applied to the affected nail twice a day for 6 months. The cure rate for toenail fungus was found to be on par with using the cream clotrimazole. Another study didn't show any improvement while using tea tree oil, but it only ran 8 weeks, so perhaps more time was needed.
Vicks VapoRub for nail fungus
Almost everyone has a jar of this at home to soothe coughs, but some people think it can help with toenail fungus too. The rub contains camphor, eucalyptus oil, and menthol, ingredients that have antifungal properties. You apply it daily on the affected toe with a cotton swab. In a small study of 18 people, at the end of 48 weeks (almost 1 year), 28% were completely cured and 56% were partially cured of toenail fungus.
Apple cider vinegar for toenail fungus
Vinegar does fight fungus, but no studies have been done as to whether it will cure toenail fungus. If you wish to try it, mix one part apple cider vinegar to three parts warm water. Soak your feet for at least 10 minutes, but longer is better (up to 40 minutes).
Baking soda for toenail fungus
One small study found that treating affected nail samples with baking soda stopped fungal growth in 79% of cases and reduced it in 17% of cases, compared to samples not treated with baking soda. This was after 7 days of treatment. This means baking soda is more likely to prevent fungi than kill it. Some people advocate making a foot soak with baking soda, while others make a paste to apply to the toe. You can also sprinkle baking soda on your feet to absorb moisture.
Other home remedies for toenail fungus
Other remedies you may see on the internet include Listerine mouthwash and snakeroot extract, which comes from a plant in the sunflower family. One study on snakeroot extract found it worked as well as the drug ciclopirox. In the study, the extract was given in a nail polish that was painted on the nail over a 6-month period.
Listerine contains thymol, which does have antifungal properties. But Listerine has never been studied as a toenail fungus cure. If you want to try it, follow the recipe for using apple cider vinegar, substituting the mouthwash for the vinegar.
The upside of using home remedies is that the ingredients don't have any side effects, so it doesn't hurt to try them. But many of them only treat the symptoms rather than the infection itself. So talk with your doctor if you think you have toenail fungus, rather than just relying on home treatments.
While treating your toenail fungus, keep your nails trimmed to reduce the pressure and pain you feel. You can also thin your nail bed by filing it down.
Toenail Fungus Treatment Side Effects
The main antifungal pills have side effects. Terbinafine can cause:
- An itchy rash
- Headaches
- Diarrhea
- Nausea or a stomachache
In some cases, it can affect your liver, so your doctor will often do a blood test to make sure this is not happening.
Itraconazole has the following side effects:
- Diarrhea
- Constipation
- Gas or bloating
- Headache
- Stomachache
Certain drugs like Pepcid AC and Prilosec can interact negatively with itraconazole, so be sure to let your doctor know what other drugs you're taking before starting itraconazole. It can also rarely cause liver problems.
The main side effect of ciclopirox is redness at the spot where you apply it. In rare cases, you could have pain, itching, burning, or oozing where you apply it.
How to Prevent Toenail Fungus
There's a chance the infection can come back – even if you get rid of it. So take these simple steps to help prevent that:
- Keep your feet clean and dry.
- Wear shower shoes on wet pool decks, in public bathrooms, and in locker rooms. Many people pick up fungi from walking barefoot in communal areas.
- If a family member has toenail fungus, wear flip-flops or shower shoes in the shower so that you don't catch it from them. Or use a different shower if possible.
- Change your shoes and socks every day. Wear ones that breathe and don't fit too tight. Acrylic socks are actually better than cotton for taking sweat away.
- Be sure your nail salon sanitizes nail tools.
- Clean the nail clipper you use at home.
- Soak your nails in warm water before cutting them, or cut right after your shower.
- Trim your nails short and straight across. Don't round the edges. Keep your toenails shorter than the end of your toes to prevent fungus coming in.
- Don't rip your nails on purpose. Fungus can enter through torn nails.
- See your doctor if you think your toenail fungus has returned.
Takeaways
Toenail fungus is a common condition and can take a long time to go away. Be patient and take the medication or cream your doctor prescribes for as long as is necessary. Prevent toenail fungus by wearing shower shoes or flip-flops in public places like locker rooms or swimming pool decks. Home remedies are best paired with prescription medication for faster results.
Toenail Fungus Treatment FAQs
What kills toenail fungus instantly?
Nothing kills toenail fungus right away. It can take at least 6 months to as long as 18 months to see your nail return to normal.
What kills toenail fungus the fastest?
A prescription medication like terbinafine will work faster than a home remedy, but you'll still need to take it for about 12 weeks.
How can I treat toenail fungus myself?
You can try OTC antifungal creams, gels, and nail polishes or home remedies like Vicks VapoRub or tea tree oil. Be sure to trim and thin your nails while you do this. Give it a few months to see improvement. Depending on how bad your fungus is, you may still need to see a doctor.
What happens if you leave toenail fungus untreated?
It can spread to other toes, or to other parts of the body, giving you athlete's foot or jock itch. If you have diabetes, you're at a higher risk of getting sores that do not heal. Diabetes makes you more likely to have other problems from minor foot issues.
