Best Otc Toenail Fungus Treatment

You also might want to opt for an oral medication if more than one nail is affected.

What is the best over-the-counter nail fungus treatment?

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Dec 7, 2021.

Official answer

by Drugs.com

There really is no ‘best’ over-the-counter (OTC) treatment for nail fungus. OTC products are available to treat fungus on the skin around the nail bed, but are not very effective at treating the hard nail bed. Prescription medicines, which you either take by mouth or apply to the nail, are more effective for nail fungus.

A fungal infection of the nail is called onychomycosis. Fungus growing under your nails can appear as a white, yellow, brown or black color with a crumbly texture. Fungal nail infections occur most frequently in the toenails, but can occur on the fingernails, too.

Be sure to treat any athlete’s foot (tinea pedis) you may have as well, as these can worsen or lead to fungal nail infections. Effective antifungal products like creams or sprays for athlete’s foot can be found over-the-counter.

Treatment for nail fungus can take months, but not all people need to be treated. While the nail fungus may not fully clear up, in many people it may not cause any long-term effects, either.

What over-the-counter products treat nail fungus?

Over-the-counter (OTC) nail fungus medicines include:

• clotrimazole (FungiCure Intensive)
• tolnaftate (Fungi-Nail, Opti-Nail)
• undecylenic acid

These OTC products treat the fungus on the skin around the nail bed and not the actual nail fungus itself.

Urea (Kerasol) can help to soften and improve the appearance of brittle, yellow nails, but it does not treat the nail fungus.

Which prescription products treat nail fungus?

The best products for nail fungus are prescription medicines you take by mouth or topical liquid medicines you apply to the nail.

Prescription medicines commonly used to treat nail fungus (onychomycosis) include oral and topical treatments, such as:

• topical efinaconazole (Jublia)
• topical tavaborole (Kerydin)
• topical ciclopirox (Ciclodan, Penlac Nail Laquer)
• oral terbinafine (Lamisil)
• oral itraconazole (Sporanox)

Oral antifungal medicines tend to work better than topical ones, but are associated with greater side effects and drug interactions. In some cases, your doctor may decide to combine treatments, or use laser or photodynamic therapy. Speak with your podiatrist (foot doctor) about these techniques.

In the most severe cases, your doctor may recommend you have surgery to remove part or all of the nail.

This is not all the information you need to know about this condition and does not take the place of your doctor’s directions. Always discuss any questions you have with your doctor or other health care provider.

• Nail Fungus: Treatment and Diagnosis. American Academy of Dermatology. Accessed Dec. 7, 2021 at https://www.aad.org/public/diseases/a-z/nail-fungus-treatment
• Patient education: Fungal nail infections (The Basics). Up to Date. Accessed Dec. 7, 2021 at https://www.uptodate.com/contents/fungal-nail-infections-the-basics
• Goldstein A, et al. Onychomycosis: Management. Up to Date. Accessed Dec. 7, 2021 at https://www.uptodate.com/contents/onychomycosis-management

Related medical questions

• What home remedies work well for toenail fungus?
• How do I get rid of nail fungus?
• Does fluconazole flush out yeast/discharge?
• Can I wear nail polish if I have nail fungus?
• Can clobetasol be used for toenail fungus?
• Is nail fungus contagious?

Drug information

• Terbinafine Information for Consumers
• Terbinafine Information for Healthcare Professionals (includes dosage details)
• Side Effects of Terbinafine (detailed)

Related support groups

• Terbinafine (22 questions, 58 members)
• Fungal Infections (16 questions, 67 members)
• Onychomycosis (6 questions, 9 members)

The 7 Best Toenail Fungus Treatments of 2023

Danielle Zoellner is a freelance writer with an emphasis in health and wellness. She graduated from the University of Missouri at Columbia.

Jennifer Nied has written about health, fitness and wellness for over 10 years. She has a degree in magazine journalism from Northwestern University’s Medill School of Journalism.

Sarah is a freelance writer with a focus on health and wellness. She has written for publications like Women’s Health, Healthline, and Parents. She taught creative writing for five years, and has a bachelor’s degree in English from Southern Connecticut State University.

Updated on August 05, 2022

Leah Ansell, MD, is board-certified in cosmetic and medical dermatology. She is an assistant professor at Columbia University and works in private practice in New York City.

Toenail fungus is a common fungal condition that often starts after a rash on the foot spreads to the nails. When mild, it looks like white and yellow spots growing under the nail beds. If left untreated, the fungus can grow severely by hardening the nails and spreading to other toes.

Reviewed & Approved

Lamisil Terbinafine Antifungal Cream treats fungus all over the body, including athlete’s foot, making it the best overall choice. The Fungi Nail Anti-Fungal Ointment is infused with five oils and makes for a budget-friendly option.

“The more severe the toenail fungus, the thicker the nail, and the more nails involved makes it that much harder to treat the nails even with effective therapies,” says Shari Lipner, MD, a board-certified dermatologist at New York-Presbyterian Hospital/Weill Cornell Medicine. The fungus often begins in the form of athlete’s foot between the toes or on the soles of the feet. At this stage, the fungal infection is easier to treat with over-the-counter medication, and that’s where toenail fungus treatments come in. In addition to understanding stage and severity of your toenail fungus when shopping for treatments, you should carefully assess the ingredients and the type of treatment for the fungus based on its location.

We researched dozens of toenail fungus treatments and evaluated them based on the following attributes: cost, medication forms, ingredients, and treatment areas.

What to Look for in a Toenail Fungus Treatment

Severity

Toenail fungus, if left untreated, can become a tough problem to treat and will greatly influence what medications you need. In fact, it’s best not to wait until your problem is severe before starting some kind of treatment, especially if you’re hoping to stick with OTC products.

“Toenail fungus is very hard to treat, and even under the care of a dermatologist it doesn’t always resolve,” says California-based dermatologist Caren Campbell, MD. “Given how difficult it can be to treat, it’s best to get in to see a dermatologist as soon as possible to avoid it worsening.”

Furthermore, the fungus can spread to other nails and other areas of the body, adds Dr. Campbell, another reason why early treatment is ideal. If you notice the fungus spreading, or if your toenails have become thick and yellowed, you might need either a prescription-strength product or to seek help from a board-certified dermatologist.

Location

Dr. Lipner says toenail fungus starts as athlete’s foot: “It begins with a rash on the foot and spreads to the toenails,” she says.

Since treating athlete’s foot differs from treating toenail fungus, you’ll have to pay attention to where your problem is on your foot. Athlete’s foot can be addressed with antifungal ointments, sprays, and powders available over-the-counter, but if your fungus has moved to under the nail or the surrounding skin, says Dr. Campbell, you’ll need to focus on treating it with topical creams, ointments, and polishes, or oral medications.

Ingredients

Zinc undecylenate and undecylenic acid are both FDA-approved ingredients to treat toenail fungus. Also, if you seek help from a dermatologist, they will likely prescribe medications in the “azole” family. “The compound interferes with the synthesis of the fungal cell membrane,” Dr. Lipner says, which essentially kills the fungus.

One common medication in the “azole” family used to treat toenail fungus is Jublia (efinaconazole). Other medications often prescribed include the active ingredient terbinafine, which is usually prescribed as oral or topical Lamisil.

Type

Toenail fungus treatments can come in a variety of forms, but oral, topical, and homeopathic medications are the most commonly used for treating toenail fungus.

Oral Medications

Oral medications have been proven effective, but they take time to work.

“Lamisil also has the lowest side effect profile of the oral antifungal medications and works as a fungicidal which destroys a fungus by blocking its ability to ‘breath’ or make the oxygen molecules it needs to survive,” says Orit Markowitz, MD, founder and CEO of OptiSkin treatment center in New York City.

But there are several conditions that can make people ineligible for oral antifungal medications. The same underlying comorbidities, including chronic renal failure (with dialysis) and renal transplant, immunodeficiency, diabetes, cancer, and peripheral arterial disease that make someone more susceptible to toenail fungus also make them more at risk for side effects when taking the drugs. Speak with your doctor to ensure you can safely take an oral antifungal.

If you’re eligible for oral drugs, however, you may want to take a multi-pronged approach: “I prefer to do orals and topicals if patients really want a chance at a cure, since it is so difficult to treat nail fungus,” says Dr. Campbell.

You also might want to opt for an oral medication if more than one nail is affected.

“[You] might use [Lamisil] if there are multiple nails involved,” says Michelle Henry, MD, founder of Skin & Aesthetics Surgery of Manhattan, “because oral treatment is significantly more effective in clearing the fungus.”

Topical Medications

Topical treatments (like amorolfine and ciclopirox) can help with minor toenail fungus. They cause fewer and less serious side effects. But, it’s difficult for them to penetrate the nail plate so treatment is longer and efficacy is low.

“Azole antifungals like Jublia inhibit fungal elements involved in the biosynthesis of critical fungal elements like fungal cell membranes,” says Dr. Markowitz. She adds that, “topical therapies can be effective, but require lengthy and costly regimens without an established method for predicting outcome.” It could mean daily topical treatments for 52 weeks.

Natural/Homeopathic Medications

Natural preventative measures can be effective, but once fungus sets in, your best bet is a research-backed and FDA approved oral antifungal. Garlic has antifungal properties, and when used in a footbath can provide some relief.

“Given that topical prescription remedies take at least one year of daily use to work in only two thirds of mild to moderate cases, it is difficult to recommend an off-label natural remedy treatment,” says Dr. Markowitz.

You could also try tea tree oil in conjunction with other more traditional treatments, says Dr. Henry, or even white vinegar: “I often recommend white vinegar soaks: patients [put] a quarter cup of white vinegar in a bowl and soak the toenail once or twice a day.”

A complete cure can take as long as 18 months; while you wait, Dr. Campbell suggests washing your socks in hot water to prevent reinfection and using antifungal powders, like Zeosorb, in your shoes. Keep in mind that for fungal nail infections, a cure is not achieved at all in 20 to 25 percent of treated patients.

“I’ve always counseled patients that even oral medications [only] work approximately 60% of the time, so it’s oftentimes a chronic condition,” says Dr. Campbell.

Frequently Asked Questions

How long should I use a toenail fungus treatment?

Antifungal medications take some time to fight the fungus. Most products recommend twice daily application for one to two weeks, but the reality is that you’ll likely need to treat the fungus for much longer than that.
“Toenails take a year to grow out,” says Dr. Campbell. “Oral treatment is usually three months, [while] topicals need to be used for 12 months.”
If you’re treating your fungus at home and nothing changes after you’ve used the product for the prescribed time, consult your doctor for treatment recommendations and next steps.

Can topical toenail fungus treatments cause irritation?

The active ingredients in most antifungal treatments are quite potent. That means they do have the power to cause burning, stinging, swelling, irritation, redness, bumps, and other irritation on the skin. If this occurs with use, consult your doctor. But, most people are able to use the antifungal creams and gels without problems and with healing, soothing effects. “Terbinafine, or lamisil, is typically well tolerated,” says Dr. Henry. “However, undecylenic acid is often included in OTC treatments [and that] can cause irritation to the skin if used improperly.”

Below, you’ll find the best toenail fungus treatments on the market today.

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