What Are the Best Treatments for Toenail Fungus (Onychomycosis)?

Toenail fungus (onychomycosis) is a very common problem for many adults, affecting around 6% of people worldwide. It’s more common as people age, but children can also get it. 

Toenail fungal infections happen when a fungus comes in contact with the nails and invades them, causing yellowing and thickening of the nails. This can be caused by walking barefoot in a public area, like a pool, or using an infected nail clipper. Fungus can also affect the fingernails, but this is less common.

There are good treatments for toenail fungus out there. But they work slowly, so you’ll need to be patient. Improvement will continue after you stop taking medication, too. Here, we’ll review the best toenail fungus treatments that will clear up your nails for good. 

Images of what toenail fungus looks like

When a fungal infection affects your toenails, it can cause changes in nail color, shape, and length, such as:

• Yellow, green, brown, or black discoloration

• Nail thickening

• Broken off or misshapen nails 

Here are some photos to help you see what toenail fungus can look like. 

Types of toenail fungus 

Different types of fungus can cause different changes to the nail. Here are the different types of toenail fungus. Keep in mind that it’s possible to have several types at once.

• Distal lateral subungual onychomycosis: This is the most common type and appears as yellow or brown discoloration at the corner of the toenail that grows inward.

• White superficial onychomycosis: This type of toenail fungus appears as white dots or spots on the nail that can be scraped off. 

• Proximal subungual onychomycosis: It appears as white or yellow patches near the cuticle. 

• Endonyx onychomycosis: This type of fungus appears as milky white patches inside the nail.

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Pills to treat toenail fungus

Oral medications (medications you take by mouth) generally work faster than topical medications that you apply to the toenail. They have higher cure rates, and the overall treatment time is typically shorter. That said, it can still take 9 to 12 months to see full results and you’ll need a prescription for these pills. These are the best toenail fungus medications. 

Terbinafine

The best pill for toenail fungus is terbinafine (Lamisil). Evidence suggests it works better than the alternatives and has the fewest side effects. Terbinafine resolves toenail fungus about 72% of the time. 

• Side effects: Common side effects of terbinafine include headaches, skin rash, and vomiting. 

• Dosage: You usually take terbinafine once a day for 6 to 12 weeks. 

Itraconazole

Another good treatment is itraconazole (Sporanox). Itraconazole cures toenail fungus about 60% of the time. 

• Side effects: Itraconazole side effects may include headaches, stomach upset, and respiratory infection. 

• Dosage: You usually take itraconazole once a day for 6 to 12 weeks. 

Fluconazole

Oral fluconazole (Diflucan, Celozole) is another pill that’s sometimes used to treat toenail fungus. It’s commonly used to treat yeast infections, but the FDA hasn’t approved it to treat toenail fungus. And it doesn’t work as well in head-to-head comparisons. 

• Side effects: Fluconazole side effects may include headache, nausea, and stomach pain. 

• Dosage: You usually take fluconazole once a week for at least 3 to 6 months.

Posaconazole

Posaconazole (Noxafil) is a newer medication used to treat toenail fungus. It’s available as a pill and as a liquid suspension. Posaconazole is usually used to treat serious fungal infections, but it can be used off-label as a toenail fungus treatment. While studies show that posaconazole is effective against toenail fungus, there are other more effective and more affordable options.  

• Side effects: Side effects of posaconazole may include diarrhea, fever, and nausea. 

• Dosage: It’s usually taken once a day for 3 to 6 months. 

Creams and topical treatments for toenail fungus

Prescription nail polishes are an option to treat toenail fungus, but they take a long time to work. And they aren’t as effective as pills for severe cases. That’s because they don’t penetrate the nail very well. That said, they’re still a good option for people with mild cases of toenail fungus, or for those who can’t take the oral medications. 

Examples include: 

• Efinaconazole (Jublia, Clenafin) (10% nail solution)

• Tavaborole (Kerydin) (5% nail solution)

• Ciclopirox (Ciclodan, Penlac, Loprox) (8% nail solution)

Side effects are usually minor and include redness or burning at the area where you apply it.

Over-the-counter and natural treatments for toenail fungus

You have some options if you’d rather try over-the-counter (OTC) treatments first. Keep in mind that these treatments are usually used to treat fungal skin infections, and they don’t work as well in the nail. Having said that, here are some of the best OTC toenail fungus treatments:  

• Terbinafine (Lamisil)

• Tolnaftate (Tinactin)

• Clotrimazole (Mycelex)

Natural treatments and home remedies for toenail fungus may be another option. Early studies suggest that these treatments may be effective, but more research needs to be done to see how well they work. Here are some natural treatments that may help:

• Tea tree oil

• Vicks VapoRub

• Propolis extract (honeybee resin)

• Spirulina (a type of algae)

Other treatments for toenail fungus infections

When medications don’t help and only one nail is affected, removing the nail partially or completely is an option. Researchers are also studying light therapy and lasers as possible toenail fungus treatments. More research needs to be done to see how effective these treatments are. 

What to watch for when taking oral medication for toenail fungus treatment

All of the pills for toenail fungus can cause liver toxicity. This is rare, and it’s reversible after you stop the medication. To prevent this complication, your primary care provider or dermatologist will run your liver function blood tests before you start treatment and midway through your treatment. 

These pills can also interact with other medications you’re taking — including supplements. Your care team will look at your medication list to make sure there aren’t any drug interactions before starting a new treatment.

Frequently asked questions

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Written by:

Maria Robinson, MD, MBA

Maria Robinson, MD, MBA, is a board-certified dermatologist and dermatopathologist who has practiced dermatology and dermatopathology for over 10 years across private practice, academic, and telehealth settings. She is a fellow of the American Academy of Dermatology and the American Society of Dermatopathology.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

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Images used with permission from VisualDx (www.visualdx.com).