Fungal infection of the nails, or onychomycosis, is a common problem. One in 10 people in the general population and one in 5 people over the age of 60 have it, and fully half of the population over the age of 70 are affected. While for many people, nail fungus is merely an unsightly problem that can be hidden by good shoes, it can be painful, or lead to complications such as cellulitis (infection of the skin) and foot ulcers (especially in those with diabetes or poor circulation). Unfortunately, medications available by prescription for this problem often cannot be given to patients who take certain other medications, or who have kidney, liver, or heart problems, and these patients are the same ones to be affected the most by onychomycosis. Even more troubling is the fact that once you take the medication (for up to a year), your chances of relapse can be as high as 50%. So, its not surprising that there is interest in nonprescription treatments and home remedies for nail fungus.
Who makes a good candidate for nonprescription treatment?
- Patients who need improvement of their onychomycosis for medical reasons (diabetes, for example), and are unable to take other medications.
- Patients who need improvement of their onychomycosis for cosmetic reasons, who do not wish to take on the risk or expense of oral medication.
- Patients who have had a relapse and wish to use these treatments in combination with oral medication. (A word of caution: Always let your doctor know if you are using alternative treatments as there could be treatment interactions.)
How well do nonprescription treatments work?
There is one small study of 110 patients, which demonstrated a clinical cure rate of 71%. This seems high, but it had a similar cure rate to ciclopirox, which is a prescription nail lacquer that has demonstrated a much lower cure rate in other clinical trials. The other problem with snakeroot extract is that it is not readily available in the United States, though it has been used in Mexico for years.
Renewed Nail (2-ethyl cyanoacrylate /undecylenic acid/hydroquinone)
One small study, conducted by the inventors of Renewed Nail, demonstrated effectiveness of the preparation of between 35% (for severe infections) to 100% (for mild infection). It is brushed on weekly after the nail is trimmed of infected areas. The treatment period is one year. A downside of this preparation is that, while it does not require a prescription, it is only available through podiatrists. You should make sure yours carries the preparation before making an appointment.
Tea tree oil or clotrimazole
One small study has been done which demonstrated similar effectiveness with clotrimazole (an over the counter antifungal cream, similar to many oral antifungals, but in this study, applied to the nail). Either one or the other were applied twice daily to the nail for 6 months, and the infected part of the nail was trimmed several times during the treatment period.
Mentholated ointment (Vicks Vaporub)
This was studied in a very small study of only 18 patients who applied Vicks Vaporub to the affected nail at least once daily over 48 weeks. It sounds a little crazy, but mentholated ointment contains several ingredients which slow the growth of fungus in the laboratory. 27.8% were cured, and a little more than half experienced partial relief.
A word about safety.
We know little about the safety of most alternative treatments. However, because the treatments discussed here are generally applied to the nail only (which has no circulation), there should be little in the way of side effects or interactions with other medications taken by mouth. If the preparation is accidentally put on the skin, it could cause an allergic reaction. Mentholated ointment has been known to irritate airways in people who already have irritable lungs (children with colds, for example) and contains camphor, which should never be used in children under the age of 2.
Other treatments available from your doctor.
You may be able to obtain other kinds of treatments from your doctor or a specialist. Some of these treatments include laser therapy and toenail removal. Laser therapy is still in its infancy. Toenail removal is very effective, but recovery can be painful and there are risks of poor wound healing and infection.
Crawford, Fay, and Sally Hollis. “Topical Treatments for Fungal Infections of the Skin and Nails of the Foot.” The Cochrane Library. Wiley Online Library, 18 July 2007. Web. 22 Feb. 2014.
Westerberg, Dyanne P., and Michael J. Voyack. “Onychomycosis: Current Trends in Treatment and Diagnosis.” American Family Physician 88.11 (2013): 762-70. Web