You don’t have to have have crumbly, discolored, unhealthy nails forever. Toenail fungus is more treatable, maybe even curable, than you think. True, it can take a while to get rid of, depending on what treatment you choose.
“I think there’s a lot of misconception out there that there aren’t a lot of good treatments,” says Shari Lipner, M.D., Ph.D., associate professor of clinical dermatology at Weill Cornell Medical College. “But there are very good options. I think there’s pretty good hope for pretty many every patient with nail fungus. Even for people with severe disease.”
Exactly how long it takes depends on what treatment ends up being right for your body and your lifestyle. We checked in with Dr. Lipner to find out exactly what to know about getting rid of the stuff:
Go to the doctor
Nail fungus may not seem worth the copay, but an hour at a dermatologist’s or podiatrist’s office can save you serious time in treatment. “It may not get better if you’re not treating the right thing,” Dr. Lipner says.
Believe it or not, you can’t guarantee it’s nail fungus just by looking at it (or by Googling it to see if yours looks like the pictures). Your doctor should take a sample and send it to a lab to get tested. “I see millions of nails and I still make a diagnosis by doing a lab test each and every time,” she says. It could be other problems, including nail cancer, nail psoriasis, or even a bony tumor under the nail.
If the lab test confirms it’s fungus, there are a number of ways to go with treatment. “There’s no one size-fits-all approach,” Dr. Lipner says. It depends on factors like your health, other meds you’re taking, your lifestyle and willingness to stay after it. To boil it down, the best treatments require a prescription oral medication, lots of patience, or both. But the payoff can make it worth it.
Find the best treatments for toenail fungus
What’s what with the most popular treatments:
“In general, oral therapies are more effective than topicals in treating fungus,” says Dr. Lipner. The CDC says the first-line treatment is terbinafine (Lamisil), and that it works up to 70 percent of the time in people who still have growing nails and their cases of fungus are mild to moderate.
But it’s not right for everyone. How well you’re suited to it depends on many factors including your health and what else you’re taking. This drug can come with side effects—famous one being liver damage. “Can liver injury happen? Yes, but it’s exceedingly rare,” says Dr. Lipner. Docs often do liver function tests before, during and after treatment. A second-choice med is itraconazole (Sporanox); a drug called fluconazole (Diflucan) may also be used.
How long it takes to get rid of toenail fungus with oral therapies: About three months. Keep in mind that the nail still needs to grow out. So the fungus might be gone in a short time but it could be a year until your nails are completely clear again.
Topical prescription remedies
There are three main topical products for toenail fungus: tavaborole (Kerydin), which comes in a dropper; efinaconazole (Jublia), which is a cream; and one form of ciclopirox (Penlac) which has a brush and is applied like nail polish.
Why wouldn’t you choose these first, over pills that you swallow? It takes about a year to get rid of toenail fungus this way—and that’s assuming you’ve been really diligent about applying the stuff every day.
Treating nail fungus with a laser sounds amazing—shoot a beam of light at the problem and it evaporates. Except there’s not a lot of evidence that it does, says Dr. Lipner. “Laser treatments haven’t been studied in the way that medications have been studied,” she says. “Right now, the evidence shows that laser isn’t effective in treating toenail fungus. Not only that, it’s hot and it’s very painful.”
Keep after your feet, even if it looks like the fungus is gone
The same fungus that causes athlete’s foot is the one that will infect the nails. So after you’ve treated the fungus and it looks like it’s out, “the patient still has a lot of responsibility,” Dr. Lipner says. You need to make sure it doesn’t come back by applying an antifungal product—a basic athlete’s foot product—to your feet daily. If you get the fungus invading your feet, you’ll probably get it back in your nails, too. “Apply an antifungal cream, spray, or powder to the shoes or the feet daily,” she says. To some people, it’s a habit like brushing your teeth. For others, getting them to do it is like pulling teeth.
Know the truth about OTC remedies
When it comes to off-the-shelf toenail fungus products, “there’s probably no harm in using these medications,” says Dr. Lipner. “But the efficacy is not very good. So you’re probably wasting your time, and you’re probably wasting your money.”
Same with the home remedy of using Vicks VapoRub. “It works okay on a not-so-common type of foot fungus, but for the one most people have, it doesn’t work well,” she says. “I think people believe that OTC products are safer in some way, but the reality is that they haven’t been approved by the FDA—they haven’t gone through extensive testing on thousands of patients. Why would you use products that haven’t been very well studied?”