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Onychomycosis (cont.)

What Are Fungal Nail Infection Treatments?


In the past, medicines used to treat fungal nail infection were minimally effective. Fungal nail infection is difficult to treat because nails grow slowly and receive very little blood supply. However, recent advances in treatment options, including oral (taken by mouth) and topical (applied on the skin or nail surface) medications, have been made. Newer oral medicines have improved treatment of fungal nail infection. However, the rate of recurrence is high, even with newer medicines. Treatment has certain risks, and recurrence is possible.

  • Topical antifungals are medicines applied to the skin and nail area that kill fungi and some other pathogens.
    • These topical agents should only be used if less than half the nail is involved or if the person with fungal nail infection cannot take the oral medicines. Medicines include amorolfine (Curanail, Loceryl, Omicur), which is approved for use outside the United States, ciclopirox olamine (Penlac, which is applied like nail polish), efinaconazole (Jublia), sodium pyrithione, bifonazole/urea (available outside the United States), propylene glycol-urea-lactic acid, ketoconazole (Nizoral cream, Xolegel), such as terbinafine (Lamisil cream), tavaborole 5% solution (Kerydin), toliaftate (Tinactin), naftifine (Naftin), butenafine (Lotrimin), griseofulvin (Gris-PEG), ciclopirox (Ciclodan), miconazole (Zeasorb), clotrimazole and tioconazole.
    • Topical treatments are limited because they cannot penetrate the nail deeply enough, so they are generally unable to cure fungal nail infection. Topical medicines may be useful as additional therapy in combination with oral medicines. This results in treatment medicine concentrations that come from two directions, topically and from within the body via oral medicine.
  • Newer oral prescription medicines are available. These antifungal medicines are more effective because they go through the body to penetrate the nail plate within days of starting therapy.
    • Newer oral antifungal drugs terbinafine (Lamisil tablets), fluconazole (Diflucan), and itraconazole (Sporanox capsules) have replaced older therapies, such as griseofulvin, in the treatment of fungal nail infection. They offer shorter treatment periods (oral antifungal medications usually are administered over a three-month period), higher cure rates, and fewer side effects. These medications are fairly safe, with few contraindications (conditions that make taking the medicine inadvisable), but they should not be taken by patients with liver disease or heart failure. Before prescribing one of these medications, doctors often order a blood test to make sure the liver is functioning properly. Common side effects include nausea and stomach pain.
    • Fluconazole (Diflucan) is not approved by the Food and Drug Administration (FDA) for treatment of fungal nail infection, but it may be used by some clinicians as an alternative to itraconazole and terbinafine.
  • To decrease the side effects and duration of oral therapy, topical and surgical treatments (see below) may be combined with oral antifungal management.


Surgical approaches to fungal nail infection treatment include surgically or chemically removing the nail (nail avulsion or matrixectomy).

  • Thick nails may be chemically removed by using a urea compound. This technique usually should be deferred to a surgeon or dermatologist.
  • Surgically removing the nail plate (fingernail or toenail) is not effective treatment of fungal nail infection without additional therapy. This procedure should be considered an adjunctive (additional) treatment combined with oral medical therapy.
  • A combination of oral, topical, and surgical therapy may increase the effectiveness of treatment and reduce the cost of ongoing treatments.

Laser Treatment

One of the newest treatments to kill pathogens infecting the nails is laser therapy. The laser beam can penetrate the nail tissue and disrupt fungal and other pathogens enough to kill them. Some patients may experience some mild discomfort or pain during the procedure. Reports suggest that laser therapy is about as effective as medical therapy. Some patients may require more than one treatment. This treatment can be very expensive, and the cure rate is poor.

Last Reviewed 11/17/2017

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Onychomycosis »

Onychomycosis (OM) refers to a fungal infection that affects the toenails or the fingernails.

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