How to Eliminate Toenail Fungus

Although toenail fungus infection is quite common, its treatment is often challenging. From oral and topical medications to natural remedies, success rates are variable.

Reviewed and approved by the dermatologist Maria del Carmen Hernandez.

Written by Daniela Echeverri Castro

Last update: 27 August, 2024

Toenail fungus is an infection whose treatment often represents a challenge. Although there are different drugs, topical formulas, and natural remedies that help promote relief, restoring the healthy appearance of the nail takes time. If you’re looking for how to eliminate toenail fungus, stick around and discover—in more detail—six available options and what effects to expect.

Fungal infections of the toenails are also known as onychomycosis or ringworm of the nail. Under normal conditions, nails have a bright pink hue and a smooth surface, without marks or grooves. However, once they’re infected, you may see changes in their appearance, such as yellowish or whitish discoloration, thickening, and breakage.

Most of the time, these symptoms are seen in the nail of the big toe, which becomes infected 10 times more frequently than the rest of the nails. Even so, fungal infections can compromise other nails or several at the same time. In fact, sometimes they occur as a complication of tinea pedis (fungus on the feet), which, when effective treatment is lacking, can spread to the nail area.

Fungi called dermatophytes — especially Trichophyton spp. — are responsible for up to 80% of cases of this infection. The remaining cases are associated with yeasts and molds (such as Aspergillus, Scopulariopsis, and Fusarium). The humid and warm environments of swimming pools, public showers, changing rooms, and closed footwear are associated with the growth of these microorganisms.

Treatment options to eliminate toenail fungus

1. Oral antifungal medications

The first line of treatment to eliminate toenail fungus is oral antifungals. These are preferred because their healing rate is higher and, therefore, they require shorter periods to achieve their effect in comparison to topically applied products. The most recommended are the following:

• Terbinafine (Lamisil): Preferred because it provides better results in lightening the nail. It’s effective for both dermatophytic and non-dermatophytic fungi. The suggested dose to combat toenail fungus is usually 125 milligrams per day, for 12 weeks.
• Itraconazole (Sporanox): Its cure rate for fungal infections reaches 80 – 85% and has a relapse rate of 10%. It helps fight dermatophytes, candida, and pityriasis. The administration schedule is usually suggested at intervals to reduce the risk of side effects. For onychomycosis in the feet, the dose is usually 200 milligrams every 12 hours, one week a month, for three months.
• Fluconazole (Diflucan): Its cure rate is 90 to 95%. Its administration regimen is pulsatile, with suggested doses of 150 milligrams weekly for at least 6 months. It’s usually recommended if the patient doesn’t tolerate terbinafine or itraconazole.

Oral antifungal therapy isn’t free of adverse reactions and risks. As a preventive measure, your doctor may suggest blood tests periodically during treatment to detect possible abnormalities.

Because these drugs can cause liver and kidney damage and interactions with certain medications, they aren’t recommended in all cases. Hence the importance of using them only under professional supervision.

2. Topical antifungals

If you’re not a candidate for oral antifungals, or if the infection is mild or just beginning, the suggested treatment to eliminate toenail fungus is topical antifungals.

They’re classified as the “alternative to first-line treatment” and, although less effective, their use is more common given their low risk of adverse effects and interactions with other medications.

Their application period is a minimum of 48 weeks for onychomycosis of the feet. In order to increase the chances of success, the doctor, dermatologist, or podiatrist intervenes with a preparation of the affected nail or nails. To do this, they cut, file, and, if possible, scrape the remains under the nail.

What’s sought through this approach is to reduce the thickness of the nail so that the drug reaches the fungus more easily. For this same purpose, over-the-counter lotions containing urea are sometimes used. Once this is done, you can continue with the application of the medication. The options can be as follows:

• Medicated nail lacquers or polishes: These transungual delivery systems are preferred over creams or ointments as they provide more optimal penetration of the drug into the nail. The most used ones contain amorolfine orciclopirox. Both have exhibited good antifungal potential although they have different mechanisms of action.
• Creams or ointments: Options such as efinaconazole and tavaborole are recommended. Reducing the thickness of the nail is decisive to achieve better results with its application.

The possible side effects of these medications are mild; they may include redness, burning, or stinging of the nail.

3. Photodynamic therapy to eliminate toenail fungus

One of the emerging treatments for onychomycosis is photodynamic therapy (PDT). It consists of the application of photosensitizing substances that manage to accumulate in fungal cells. Then, after exposing the affected nail to light of a specific wavelength, they generate reactive oxygen species that inhibit cell replication and lead to the death of the fungus.

According to the results of some research, this treatment has several advantages over conventional therapeutic options:

• The spectrum of action is broader.
• It fights antimicrobial resistance.
• There’s a minimal risk of side effects.
• They can be combined with antifungal medications.
• They provide the possibility of activating the photosensitizing substance with low-cost lights.
• There are formulations available that allow the specific release of the photosensitizer to the area.

It’s important to consider that this treatment option should be applied only by a dermatology professional. Between four and eight sessions are required to achieve satisfactory results.

4. Combined therapy

The protective structure of the nail makes it difficult to completely eliminate fungus with just one type of treatment. For this reason, today, doctors recommend combined therapy as a more effective modality. Evidence suggests that both combination antifungal therapy and the simultaneous use of antifungals and photodynamic therapy give good results.

By using drugs and therapies with different mechanisms of action, the fungal eradication rate increases. In addition, response time decreases and a more significant improvement in symptoms is evident.

5. Chemical or surgical removal of the nail

When medical treatment fails or nail ringworm is very severe, the doctor may suggest chemical or surgical removal of the nails. These are interventions in which a partial or total removal of the affected nail is carried out in order to enable a more direct application of the antifungal medication on the fungus and also to eliminate infected nail tissue.

• In chemical extraction, a keratolytic agent is used for several weeks to gradually weaken the nail structure and thus carry out the removal.
• During a surgical removal (reserved for the most serious cases), the doctor applies a local anesthetic and proceeds with the removal.

6. Natural remedies

In various systems of holistic medicine, a series of natural remedies are recommended as an option to treat and eliminate toenail fungus. Reported data suggest that they’re useful in providing temporary relief of symptoms and, sometimes, in improving the appearance of the nails. However, there are no rigorous scientific studies to support their effectiveness.

Their application is often suggested as a complement to the aforementioned medical treatments. Like other topical solutions, their effects take months before becoming noticeable. If onychomycosis is severe, they may have little or no effect. If so, it’s best to go to the dermatologist or podiatrist.

Among the most used, the following stand out:

• Tea tree oil: Evidence suggests that this ingredient has antifungal properties that are useful against the fungi that cause onychomycosis. To use it, dilute three to five drops of tea tree essential oil in 10 milliliters of carrier oil (coconut, olive, almond). Then, apply it directly to the affected nail.
• Thyme oil: This oil has antifungal potential that’s associated with its main active compound, thymol. As in the previous case, dilute the thyme essential oil in a carrier oil (proportion of five drops per 10 milliliters), before applying it to your nails.
• Vinegar: Anecdotal data suggests that vinegar (50:50 with water) can help combat both toenail fungus and athlete’s foot. However, there’s no evidence of its effectiveness. It has been suggested that its simultaneous use with topical antifungals may result in improvements in onychomycosis.
• Vicks VapoRub Ointment: The active ingredients in this menthol ointment —eucalyptus oil, menthol, and camphor—help fight toenail fungus. You should only apply a small amount to the affected area, at least once a day.
• Baking soda: Some evidence suggests that baking soda has antifungal properties that help stop fungal growth. However, studies remain limited. Its use as a remedy to combat onychomycosis is largely supported by anecdotal evidence. To do this, pour 100 grams of baking soda into a bowl of water and immerse your nails in it for 15 minutes.

What’s the most effective way to eliminate toenail fungus?

As you’ve just seen, there are multiple treatment options when it comes to combating toenail fungus. However, it’s difficult to establish which is the ideal or most effective option. In general, this depends on the severity of the infection, the number of nails affected, and other factors.

Evidence suggests that oral antifungal drugs—which are the first line of treatment—offer a higher cure rate than topical antifungals. However, given their high risk of adverse effects, not everyone is a candidate for using them.

Combination therapies, in accordance with recent findings, have the potential to increase treatment success, reduce the application period, and, in general, minimize adverse effects. Other more innovative methods, such as photodynamic therapy, have been generating interest from patients and professionals, given their rapid results with minimal risks.

Potential treatments such as patches, varnishes, gels, and some naturally derived ingredients are still being investigated. Preliminary studies suggest that they may help in cases of mild onychomycosis; although preferably in combination with medications.

Are there ways to prevent toenail fungus?

There’s no method that guarantees the absolute prevention of toenail fungus infections. In fact, it’s possible to suffer from these infections again after successfully completing any of the aforementioned treatments. In any case, there are certain precautions that help reduce the risk of contracting them. Take note and put them into practice!

• Make sure to keep your feet clean and dry. Once you finish showering, dry your feet well, especially the spaces between your toes. Don’t forget that fungus can proliferate if moisture remains on the feet.
• Avoid walking barefoot in wet public places: Especially in gyms, swimming pools, showers, or locker rooms. Have sandals or water shoes on hand.
• Keep nails short and clean: The longer the nails, the more room the fungus has to thrive. This gets worse if they accumulate dirt.
• Choose appropriate footwear: Make sure socks and shoes are breathable and that their materials don’t increase foot sweating. If possible, alternate between multiple pairs of shoes so they can dry well between wears.
• Wear cotton socks: Synthetic materials retain moisture and increase the risk of fungus. After a sporting activity or after sweating for another reason, be sure to change your socks for clean ones.
• Avoid sharing items meant for personal use: Such as nail clippers, files, socks, and shoes. Fungi spread easily through these.
• Limit the use of nail polish or artificial nails: Excessive use creates an ideal environment for the growth of microorganisms.

When to consult the doctor

Cases of mild onychomycosis may improve with home treatment, either with over-the-counter topical medications or with frequent use of natural remedies. However, when the symptoms don’t improve—and on the contrary become chronic—it’s best to go to the doctor or dermatologist to learn about other therapeutic options.

Depending on how affected the nail is, as well as the fungi involved in the infection, the professional will determine if oral therapy, topical drugs, or any of the nail removal methods are necessary (severe cases).

Remember!

The presence of toenail fungus can become a persistent discomfort if intervention isn’t done in a timely and appropriate manner. Although they don’t usually cause symptoms beyond changes in the appearance of the nail (discoloration and thickening), toenail infections are contagious and can spread to more than one nail.

Treatment options are becoming broader, but their success rates vary depending on the type of fungus, the severity of the infection, and the individual response to the medication or product.

In general, it takes several months of management before seeing results. Even so, it doesn’t always work or the fungus reappears. It’s important to evaluate with your doctor the pros and cons of each therapeutic option and choose the one that best suits the case.

Finally, it’s important to keep in mind that hygiene and daily care of the feet are essential to prevent fungi from proliferating and generating infection in the nails. This is even more important if you have any associated risk factors, such as athlete’s foot, diabetes, nail dystrophy, or circulatory problems.