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Toenail fungus is probably the topic that readers have asked us most about over the years. That’s not surprising since it is so common, so unpleasant, and so hard to treat. The fungus causes the toenail, particularly on the big toe, to thicken and discolor; the end may separate from the nail bed. Often, the nail is so thick you can’t cut it. In severe cases, the nail may detach and fall off.
Medically known as onychomycosis, toenail fungus is increasingly common, possibly because of lifestyle changes and an aging population. Though estimates vary, about 10 percent of Americans have it, and this increases to about 20 percent in people over 60 and up to 50 percent of those over 70. More men than women get it.
Diabetes, vascular problems, and impaired immunity are risk factors. About one-third of people with diabetes have toenail fungus. Smokers are at increased risk, too. It may be related to being sedentary, poor foot hygiene, nail trauma, family history, and genetics. There’s also a strong link between toenail fungus and athlete’s foot. Moist socks and shoes present an ideal environment for fungi, which helps explain why toenail fungus is less common in societies where people don’t wear shoes. On the other hand, going barefoot in damp areas also increases the risk.
Though usually just a cosmetic issue, toenail fungus can cause pain and difficulty walking, not to mention self-consciousness when wearing sandals or going barefoot. The diseased nails can cause ulcerations or breaks in the skin, which, by serving as an entry for bacteria, can result in serious infections (for example, cellulitis). This can be especially problematic in people with diabetes, who are already predisposed to foot problems and infections.
Toenail fungus is notoriously difficult to cure and rarely goes away on its own. Standard treatments are only moderately effective and, even when they work, the fungus may return. Which treatment you choose depends on the severity of the condition, the cost and other medical conditions you may have.
Alternative Toenail Fungus Treatment
Q: Do any alternative remedies work for toenail fungus?
A: Some may hold promise, but overall there’s little or no evidence that they are effective. Countless remedies have been tried for toenail fungus, including tea tree oil, olive oil, vitamin E, Campho-Phenique, oil of bitter orange, and Listerine. Some, such as dipping toes in beer, are innocuous, but dipping them in bleach can be harmful.
Various essential oils—such as clove, oregano, thyme, and lavender—have been shown to have antifungal activity, but studies are needed to determine if they can penetrate the nail bed, according to a “mini-review” in Mycopathologia this year.
Two products have some very preliminary evidence behind them. A small study in the Journal of the American Board of Family Medicine in 2011 found that 15 out of 18 people with toenail fungus had a positive response with Vicks VapoRub (which contains thymol, menthol, camphor, and eucalyptus oil). About one-quarter were “cured” after 48 weeks. Earlier this year, a study from Washington University also reported significant improvements (as well as decreases in embarrassment and discomfort) in people with HIV infection who used Vicks VapoRub for their toenail fungus. There were no side effects.
Another product is a topical resin from the coniferous Norway Spruce (Picea abies) tree, which has been tested in two small Finnish studies—though the authors were shareholders of a company that develops and markets resin-based products for medical purposes, and the product is not readily available here. In one of the studies, which was published in the British Journal of Dermatology in 2015, this nail lacquer worked as well as topical amorolfine (Loceryl)—but not nearly as well as the oral antifungal drug terbinafine.
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