What Really Works for Nail Fungus?

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Nail fungus is common and there are good treatments out there but you need to be patient. Nail changes are SLOW and improvement will continue after you stop your medication so hang in there. Here are the medications and treatments that do actually work for nail fungus.


The best pill for nail fungus is terbinafine (Lamisil) and evidence suggests it works better than the alternatives with the fewest side effects. Terbinafine results in resolution of nail fungus 76% of the time. It is taken once a day for 6 – 12 weeks. Another good pill for nail fungus is itraconazole (Sporanox) which results in cure 63% of the time. Itraconazole is also taken once a day for 6 – 12 weeks. Remember that improvement will continue AFTER oral therapy is stopped and it may take 9 to 12 months for you to see full results. Though not as effective as terbinafine and itraconazole, oral fluconazole 150 mg – 300 mg taken once a week does result in disappearance of fungus 48% of the time. A new player for nail fungus (a liquid you take by mouth) is Noxafil (posaconazole) which appears to be an effective option though the cost makes it difficult for anyone to afford.

Topical treatments:

Over the counter fungal creams like clotrimazole and the nail polishes (ciclopirox) are generally ineffective for clearing nail fungus. Ciclopirox (Penlac is the brand name) is a topical nail polish used for the treatment of mild to moderate nail fungus. It just doesn’t work very well resulting in cure only 7% of the time. Medicated chest rub (Vicks VapoRub) has some data looking at its effectiveness. In one study 18 patients applied it twice daily for 48 weeks and 4 patients had resolution. Vicks is a tempting option because it’s so safe and easy to use.

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Removal of the nail is only used when only 1 nail is infected, but it does work. Light therapy and lasers are also being studied. A multicenter trial investigating the efficacy of a device, the Pinpointe FootLaser, is currently underway so stay tuned on that.

Last thing…

All of the pills for nail fungus can cause liver toxicity so a baseline liver function blood test is required with another one midway in your treatment. Also, your doctor has to look at your medication list to make sure there aren’t any drug interactions. The liver toxicity (which is rare) is reversible after discontinuing the medication.

Treatment failures and recurrences are common so don’t get frustrated, you are not alone.

Dr O.


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