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Keeping nails trimmed and filed can help to reduce the amount of fungus in the nails and is highly recommended. A podiatrist or dermatologist may shave the top layer of the nail off or even remove part of the nail.
Creams and other topical medications have traditionally been less effective against nail fungus than oral medications. This is because nails are too hard for external applications to penetrate.
Prescription topical medications for fungal nails include the following:
Ciclopirox (Penlac) topical solution 8% is a medical nail lacquer that has been approved to treat finger or toenail fungus that does not involve the white portion of the nail (lunula) in people with normal immune systems. It only works about 7% of the time. The medication is applied to affected nails once daily for up to one year. The lacquer must be wiped clean with alcohol once a week. There is some evidence that using an antifungal nail lacquer containing amorolfine can prevent reinfection after a cure, with a success rate of about 70%. However, this drug is currently unavailable in the United States.
Efinaconazole (Jublia) is a medication approved in 2014. It is a topical (applied to the skin) antifungal used for the local treatment of toenail fungus due to two most common fungal species affecting nails (Trichophyton rubrum and Trichophyton mentagrophytes). Once-daily application is required for 48 weeks.
Tavaborole (Kerydin) is another new medication that is indicated for onychomycosis of the toenails. This medicine has the same indication as efinaconazole. It also requires application once daily for 48 weeks.
Oral antifungal therapy works about 50%-75% of the time, depending on the medication. It can take nine to 12 months to see if it has worked or not, because that is how long it takes for the nail to grow out. Even when therapy works, the fungus may come back about 20%-50% of the time.
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