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Which antifungal is right for my toe nail fungus?

Fungal infections of the toe nail come in many different stages. Which antifungal medication is right for your toe nail infection? This article explores the choices in topical medications used to treat fungal infections of the toe nail.

How do I treat toe nail fungus?

Which antifungal is the best antifungal for me?

Fungal infections of the nail (onychomycosis) cause yellow discoloration of the nail, thickening of the nail and separation of the nail from the underlying nail plate.  Infections typically begin after an incident of trauma to the nail.  A healthy nail offers a degree of protection to the nail from bacteria and fungus.  But with an injury to the nail, the nail becomes much more susceptible to infection.  Fungal infections of the nail usually begin at the distal margin of the nail and progress proximally into the body of the nail.

How do you choose the right medication to treat nail fungus?

Let's take a look at three stages of nail fungus and treatment recommendations for each stage of infection.

Early-stage - In this case, there is just a small percentage of the nail that is infected.  In early cases of onychomycosis, treatmentEarly onychomycosis with a topical medication like ClearZal or Terpenicol works to clear the nail.  Compliance is the most important aspect of care.  Fungus doesn't take a day off and neither should you.  Apply your topical medication twice a day.  Apply just enough to cover the nail.  Allow it to dry and you're good to go.  Be sure to continue application of a topical antifungal until the nail is 100% clear.  Topical antifungal nail polish is also OK to use in early-stage onychomycosis.

Intermediate stage - In the nail seen at right, we see a much greater percentage of the nail being infected.  The nail has become dystrophic andIntermediate stage onychomycosis fragmented.  The diseased nail needs to be mechanically debrided or chemically debrided with a urea-based medication.  The same medications can be used that were described in early-stage treatment, but the diseased nail should be removed either mechanically or chemically.  Natural Healthy Nail Butter, with a 40% urea base, is well suited to chemically debride the diseased nail and treat the nail fungus simultaneously.

Late-stage - In late-stage treatment of onychomycosis, debridement of the nail is essential by both mechanical and Late stage onychomycosischemical means.  It's important to recognize in late-stage onychomycosis that the nail has physically separated from the nail bed.  Although topical medications can treat the fungal component of the nail, antifungal medications will not enable the nail to re-adhere to the nail bed.  Mechanical debridement of the nail with nail cutters needs to be performed and followed with chemical debridement with Natural Antifungal Nail Butter.

Be sure to remember that nail fungus is not a condition that can be treated for a finite period (a few months) and be cured.  Effective treatment of onychomycosis requires ongoing treatment to manage the infection.


Dr. Jeffrey Oster
Jeffrey A. Oster, DPM

Medical Advisor

Updated 4/22/2021

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