Fungal nail infections can be difficult to treat because the fungus may grow within and beneath the nail, making it harder for topical medicines to reach the affected area. While several over-the-counter antifungal creams are available for skin infections, they are not necessarily effective treatments for fungal nails. The American Academy of Dermatology specifically notes that nonprescription terbinafine cream.
This is an important distinction. Common OTC terbinafine creams are designed for fungal infections of the skin, such as athlete's foot and jock itch. The American Academy of Dermatology states that these creams cannot penetrate the nail sufficiently to treat nail fungus.
Therefore, simply applying an OTC skin antifungal cream to a thick or infected toenail should not be considered equivalent to using a medication specifically formulated for onychomycosis.
For mild to moderate fungal nail infections, healthcare professionals may consider topical medications formulated to reach the nail.
Examples include:
These are prescription treatments in the United States and are applied directly to affected nails. Treatment can take many months because toenails grow slowly.
The fungus can be located within the nail plate and underneath the nail, creating a barrier that ordinary skin creams may not overcome. Nail-specific treatments are formulated to improve delivery to the affected area.
Nail trimming and professional debridement may also improve the response to topical treatment by reducing the thickness of the affected nail.
Topical therapy is generally most useful for mild or moderate infections, particularly when the infection has not extensively affected the nail or nail matrix. More extensive infections may require different treatment approaches.
Before starting treatment, confirming that the nail problem is actually fungal can be important because other nail conditions can look similar. The American Academy of Dermatology notes that about half of nails suspected of having fungus may have another cause.
For many appropriate patients, oral antifungal treatment can be more effective than topical therapy. Oral terbinafine is commonly considered a first-line treatment for onychomycosis when there are no contraindications.
However, oral medication can have risks and drug interactions, so it should be discussed with a qualified healthcare professional rather than taken without medical guidance.
Professional evaluation may be particularly useful if:
A healthcare professional can determine whether the nail changes are caused by fungus and recommend an appropriate treatment.
Not every OTC antifungal cream is capable of penetrating the nail sufficiently to treat a fungal nail infection. In particular, ordinary OTC terbinafine cream is intended for fungal skin infections and should not be relied upon as a nail-fungus treatment. Nail-specific prescription treatments such as efinaconazole, tavaborole, and ciclopirox are designed for onychomycosis, while oral antifungals may be considered for appropriate patients.