The best toenail fungus treatment for 2024, according to dermatologists
Are your toenails looking more "Hellraiser" than "Happy Feet"? If so, toenail fungus could be the culprit behind your nail nasties.
It’s an embarrassing topic no one likes to think about, let alone discuss. But the truth is that toenail fungus or onychomycosis, to use the medical term, is incredibly common and can happen to anyone. In fact, 1 in 10 people are affected, and for those over 70, this statistic jumps to 1 in 2.
Toenail fungus starts innocently enough, appearing as a small white or yellow spot under the tip of your toenail. It’s easy to overlook or dismiss as dirt or a minor discoloration. But, as it progresses, it causes unsightly, discolored and crumbling nails.
Neglecting these symptoms can result in more severe issues, such as pain and discomfort, especially when wearing shoes. To make matters worse, treating toenail fungus is notoriously tricky. Dr. Chris Adigun, a board-certified dermatologist at Dermatology & Laser Center of Chapel Hill, explains that it requires patience and that infections often recur.
She stresses that only prescription topical and oral medications are clinically proven to tackle toenail fungus, but even these, especially the topicals, often don’t guarantee a complete cure.
That said, many over-the-counter ointments, foot soaks and brush-on liquids can be effective for mild cases. Since toenail fungus is typically not a serious medical issue, it’s reasonable to try home treatment, suggests Dr. Amit Garg, a board-certified dermatologist and professor at Zucker School of Medicine at Hofstra/Northwell in New Hyde Park, N.Y.
The challenge with all these options is finding the one that works best for you. To tackle this issue, we consulted three dermatologists to understand why treating toenail fungus is so difficult and which active ingredients in OTC products have the most potent antifungal properties. Armed with this information, we researched dozens of products, evaluating them based on ingredients, ease of use, cost and customer reviews. Below are the best toenail fungus treatments for 2024, according to experts.
Factors to consider when buying a toenail fungus treatment
Active ingredients. Look for antifungals that can kill the types of fungus that frequently invade the toenail. These include terbinafine, tolnaftate, undecylenic acid (UA) and clotrimazole.
The severity of your problem. OTC products will only work for mild cases of toenail fungus. As an example, Garg says that it may look like you only have one or two nails superficially affected — that is, the nail appears affected, but not the skin under the nail. If your situation is more severe, don't mess around with home remedies. Adigun stresses that even prescription-strength topical medications aren't always effective for treating more serious fungal toenail infections.
Duration of use. Toenail fungus does not succumb easily. The experts point to prescription treatments: Topical medications are typically taken for a year, and even pills generally take three months to work. In other words, buckle up for the long haul and plan to use OTC treatments for the foreseeable future if you hope to experience results.
FAQs
Will anything kill toenail fungus instantly?
The short answer is no. Toenail fungus treatment requires consistent and ongoing application of antifungal ingredients, and even long-term treatment may not clear up challenging infections.
How long should I use an OTC treatment?
It's a tough question. A toenail takes a year or longer to grow out, Del Campo notes. So even if a treatment is knocking out the fungus, you'll probably have to wait patiently to see a completely healthy-looking nail. What all three dermatologists did say: If you've been using an OTC antifungal for two months and aren't seeing any improvement, it's time to see a doctor.
When should I see a doctor about toenail fungus?
In general, the experts say it's wise to consult a doctor as soon as you think you have toenail fungus. While Garg offered a loose definition of a "mild" case that may respond to home treatment, he says it's also tough to judge the severity of a fungal infection with your own eye, especially when you can't readily see what's going on with the tissue underneath your toenail. If you see a doctor, you'll have a better sense of the issue and can opt for OTC treatments if you prefer. If your fungal infection looks more extensive — or "if you have any doubts," Del Campo says — make that appointment.
Finally, it's important to understand that your overall health can contribute to whether or not a toenail fungal infection is more concerning. If you have a serious health condition, like diabetes or HIV, you should see your doctor at the first sign of a problem, according to the Centers for Disease Control and Prevention.
Can I prevent toenail fungus from coming back?
Fungus is everywhere, so it's hard to avoid altogether, Garg points out. Even among people who use oral medications to treat toenail fungus, 20%-25% see a recurrence, often within two years. Some people are just prone to foot fungus, Adigun says.
However, Garg says you can take simple steps to reduce the risk of a recurrence — keep your nails trimmed, change your socks regularly and sprinkle antifungal powder in your shoes. And since athlete's foot can spread to the toenails, Adigun says that treating and preventing that condition is also key.
Meet our experts
Chris Adigun, MD, board-certified dermatologist, Dermatology & Laser Center of Chapel Hill, Chapel Hill, N.C.
Danilo C. Del Campo, MD, board-certified dermatologist, Chicago Skin Clinic
Amit Garg, MD, board-certified dermatologist and professor of dermatology, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, N.Y.
Resources
Berkley A, et al. (2024). Anti-fungal properties of tea tree oil, oregano oil, lavender oil, coconut oil for nails, and a survey of pharmacy students’ views. https://crimsonpublishers.com/acam/pdf/ACAM.000680.pdf
Ousaaid D, et al. (2021). Antifungal and antibacterial activities of apple vinegar of different cultivars. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8369171/
Rodríguez JV, et al. (2022). Meta‐analysis of the antifungal activities of three essential oils as alternative therapies in dermatophytosis infections.