Fungal Nail Infection Treatments

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Treatment Overview

For many people, a fungal nail infection (onychomycosis) is more than just a cosmetic nuisance; it is a persistent and often painful condition that can affect daily confidence. The thickening, discoloration, and crumbling of the nail can make wearing shoes uncomfortable and walking difficult. It is common to feel embarrassed by the appearance of the feet or hands, leading many to hide them. While fungal infections are notoriously stubborn, they are not permanent.

Treatment is essential not only to restore the appearance of the nail but to prevent the infection from spreading to other nails or the skin (athlete’s foot). In severe cases, particularly for individuals with diabetes or weakened immune systems, untreated fungal nails can lead to serious secondary bacterial infections. Because nails grow slowly and the fungus lives deep within the nail bed, treatment requires time and patience. The choice of medication depends heavily on the severity of the infection and the patient’s general health (American Academy of Dermatology, 2023).

Overview of treatment options for Fungal Nail Infection

The primary goal of treatment is to eradicate the fungus and allow a new, healthy nail to grow in its place. Because the nail acts as a hard protective shield, reaching the fungus underneath is challenging. Consequently, treatment approaches generally fall into two categories: topical treatments applied to the nail surface and systemic medications taken by mouth.

Clinical experience suggests that while topical treatments are safer, oral medications are significantly more effective for established or thick infections. Treatment is a long-term commitment; even after the fungus is killed, the damaged nail must grow out completely, which can take several months for fingernails and up to a year for toenails. In some cases, doctors may recommend removing the nail surgically or chemically to allow medications to work better, but pharmacologic therapy remains the standard approach.

Medications used for Fungal Nail Infection

Oral antifungal drugs are considered the first-line treatment for most moderate to severe infections. The most commonly prescribed medications in this class include terbinafine and itraconazole. These drugs travel through the bloodstream to reach the nail bed, attacking the infection from the inside out. Studies show that terbinafine typically offers the highest cure rates for toenail infections (Centers for Disease Control and Prevention, 2022).

For mild cases or for patients who cannot take oral medications due to liver issues or drug interactions, topical antifungals are used. These include medicated nail lacquers like ciclopirox or newer topical solutions such as efinaconazole and tavaborole. These are applied daily or weekly, similar to nail polish, and are designed to penetrate the hard nail plate.

Fluconazole is another oral option sometimes used, though it is often considered a second-line choice depending on the specific type of fungus (yeast vs. dermatophyte). Patients should expect gradual improvement; the clear nail will appear at the base (cuticle) and slowly move outward as it grows (Mayo Clinic, 2022).

How these medications work

Antifungal medications work by compromising the structural integrity of the fungus. Fungal cells are protected by a rigid cell membrane that relies on a substance called ergosterol to stay intact. Both oral and topical drugs interfere with the enzymes the fungus needs to produce ergosterol.

When this production is blocked, the fungal cell membrane becomes unstable and “leaky.” It can no longer regulate what enters or exits the cell, causing the fungus to die or stop reproducing. Oral medications accumulate in the nail bed and remain there for months even after the patient stops taking the pills, providing a sustained attack on the infection.

Side effects and safety considerations

Oral antifungals are potent drugs that require medical supervision due to risks like potential liver damage. Doctors often require liver function blood tests before and during treatment. Other common side effects include headache, taste changes, diarrhea, or rash.

Topical medications are generally safer but may cause localized redness, stinging, or ingrown nails. Patients must inform their doctor of all medications, as oral antifungals can have dangerous interactions with blood thinners and certain heart drugs. Seek immediate medical attention for signs of liver issues, such as jaundice, dark urine, or severe fatigue (MedlinePlus, 2021).

Since everyone’s experience with the condition and its treatments can vary, working closely with a qualified healthcare provider helps ensure safe and effective care.

References

  1. American Academy of Dermatology. https://www.aad.org
  2. Centers for Disease Control and Prevention. https://www.cdc.gov
  3. Mayo Clinic. https://www.mayoclinic.org
  4. MedlinePlus. https://medlineplus.gov

Medications for Fungal Nail Infection

These are drugs that have been approved by the US Food and Drug Administration (FDA), meaning they have been determined to be safe and effective for use in Fungal Nail Infection.

Found 4 Approved Drugs for Fungal Nail Infection

Ciclopirox

Generic Name
Ciclopirox

Ciclopirox

Generic Name
Ciclopirox
Form: Gel, Shampoo, Kit, Solution
Method of administration: Topical
FDA approval date: September 18, 2007
(To understand fully the indication for this product, please read the entire INDICATIONS AND USAGE section of the labeling.) Ciclopirox Topical Solution, 8% as a component of a comprehensive management program, is indicated as topical treatment in immunocompetent patients with mild to moderate onychomycosis of fingernails and toenails without lunula involvement, due to Trichophyton rubrum. The comprehensive management program includes removal of the unattached, infected nails as frequently as monthly, by a health care professional who has special competence in the diagnosis and treatment of nail disorders, including minor nail procedures. No studies have been conducted to determine whether ciclopirox might reduce the effectiveness of systemic antifungal agents for onychomycosis. Therefore, the concomitant use of 8% ciclopirox topical solution and systemic antifungal agents for onychomycosis, is not recommended., Ciclopirox Topical Solution, 8% should be used only under medical supervision as described above., The effectiveness and safety of ciclopirox topical solution, 8% in the following populations has not been studied. The clinical trials with use of ciclopirox topical solution, 8% excluded patients who: were pregnant or nursing, planned to become pregnant, had a history of immunosuppression (e.g., extensive, persistent, or unusual distribution of dermatomycoses, extensive seborrheic dermatitis, recent or recurring herpes zoster, or persistent herpes simplex), were HIV seropositive, received organ transplant, required medication to control epilepsy, were insulin dependent diabetics or had diabetic neuropathy. Patients with severe plantar (moccasin) tinea pedis were also excluded., The safety and efficacy of using Ciclopirox Topical Solution, 8% daily for greater than 48 weeks have not been established. Clinical Trials Data - The results of use of ciclopirox topical solution, 8% in treatment of onychomycosis of the toenail without lunula involvement were obtained from two double-blind, placebo-controlled studies conducted in the United States. In these studies, patients with onychomycosis of the great toenails without lunula involvement were treated with ciclopirox topical solution, 8% in conjunction with monthly removal of the unattached, infected toenail by the investigator. Ciclopirox topical solution, 8%, was applied for 48 weeks. At baseline, patients had 20–65% involvement of the target great toenail plate. Statistical significance was demonstrated in one of two studies for the endpoint "complete cure" (clear nail and negative mycology), and in two studies for the endpoint "almost clear" (≤10% nail involvement and negative mycology) at the end of study. These results are presented below. At Week 48 (plus Last Observation Carried Forward) for the Intent-to-Treat (ITT) Population Study 312 Study 313 Active Vehicle Active Vehicle Complete Cure* 6/110 (5.5%) 1/109 (0.9%) 10/118 (8.5%) 0/117 (0%) Almost Clear** 7/107 (6.5%) 1/108 (0.9%) 14/116 (12%) 1/115 (0.9%) Negative Mycology Alone*** 30/105 (29%) 12/106 (11%) 41/115 (36%) 10/114 (9%) * Clear nail and negative mycology ** ≤ 10% nail involvement and negative mycology *** Negative KOH and negative culture The summary of reported patient outcomes for the ITT population at 12 weeks following the end of treatment are presented below. Note that post-treatment efficacy assessments were scheduled only for patients who achieved a complete cure. Post-Treatment Week 12 Data for Patients Who Achieved Complete Cure at Week 48 Study 312 Study 313 Active Vehicle Active Vehicle Number of Treated Patients 112 111 119 118 Complete Cure at Week 48 6 1 10 0 Post-treatment Week 12 Outcomes: Patients Missing All Week 12 Assessments 2 0 2 0 Patients with Week 12 Assessments 4 1 8 0 Complete Cure 3 1 4 0 Almost Clear 2* 1 1* 0 Negative Mycology 3 1 5 0 *Four patients (from studies 312 and 313) who were completely cured did not have post-treatment Week 12 planimetry data.

Jublia

Generic Name
Efinaconazole

Jublia

Generic Name
Efinaconazole
Form: Solution
Method of administration: Topical
FDA approval date: June 06, 2014
Classification: Azole Antifungal
JUBLIA (efinaconazole) topical solution, 10% is an azole antifungal indicated for the topical treatment of onychomycosis of the toenail(s) due to Trichophyton rubrum and Trichophyton mentagrophytes. JUBLIA is an azole antifungal indicated for the topical treatment of onychomycosis of the toenail(s) due to Trichophyton rubrum and Trichophyton mentagrophytes.

Tavaborole

Generic Name
Tavaborole

Tavaborole

Generic Name
Tavaborole
Form: Solution
Method of administration: Topical
FDA approval date: October 19, 2020
Classification: Oxaborole Antifungal
Tavaborole topical solution, 5% is an oxaborole antifungal indicated for the treatment of onychomycosis of the toenails due to Trichophyton rubrum or Trichophyton mentagrophytes. Tavaborole topical solution is an oxaborole antifungal indicated for the topical treatment of onychomycosis of the toenails due to Trichophyton rubrum or Trichophyton mentagrophytes.

Ultramicrosize

Brand Names
Grisofulvin, Microsize

Ultramicrosize

Brand Names
Grisofulvin, Microsize
Form: Tablet, Suspension
Method of administration: Oral
FDA approval date: September 09, 1971
Classification: Tubulin Inhibiting Agent
Griseofulvin oral suspension is indicated for the treatment of dermatophyte infections of the skin not adequately treated by topical therapy, hair and nails, namely: Tinea corporis Tinea pedis Tinea cruris Tinea barbae Tinea capitis Tinea unguium when caused by one or more of the following species of fungi: Epidermophyton floccosum Microsporum audouinii Microsporum canis Microsporum gypseum Trichophyton crateriformis Trichophyton gallinae Trichophyton interdigitalis Trichophyton megnini Trichophyton mentagrophytes Trichophyton rubrum Trichophyton schoenleini Trichophyton sulphureum Trichophyton tonsurans Trichophyton verrucosum Note: Prior to therapy, a dermatophyte should be identified as responsible for the infection. Prior to initiating treatment, appropriate specimens for laboratory testing (KOH preparation, fungal culture, or nail biopsy) should be obtained to confirm the diagnosis. Griseofulvin is not effective in the following: Bacterial infections Coccidioidomycosis Candidiasis (Moniliasis) North American Blastomycosis Histoplasmosis Cryptococcosis (Torulosis) Actinomycosis Tinea versicolor Sporotrichosis Nocardiosis Chromoblastomycosis The use of this drug is not justified in minor or trivial dermatophyte infections which will respond to topical agents alone.
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