Nail fungus (onychomycosis) is more common than you think—about one in ten adults will get it at some point. It starts slow: a white or yellow spot under the tip of the nail, then the nail thickens, crumbles, or lifts off. If you ignore it, the infection usually gets worse and can spread to other nails or skin. The good news: many treatments work, but picking the right one starts with a clear diagnosis.
First, see a clinician to confirm the diagnosis. Doctors often scrape a bit of the nail for a lab test (KOH or fungal culture) or a pathology stain (PAS) to be sure. For mild cases, medicated nail lacquers like ciclopirox or newer topical drops such as efinaconazole can help, but they usually take months and work best on early infections.
Oral antifungals are the most reliable for moderate to severe onychomycosis. Terbinafine is the common choice—250 mg once daily for about 6 weeks for fingernails and 12 weeks for toenails. Itraconazole is another option, often used in “pulse” dosing. Both can clear fungus more quickly than topicals, but they carry risks—mainly liver effects and drug interactions. Your doctor should check blood tests and your medical history before prescribing them.
In stubborn cases, combining an oral drug with a topical treatment can improve results. Nail removal—either chemically or surgically—is rarely needed but can help when pain or severe damage is present. Laser treatments and photodynamic therapy are available in some clinics; evidence is mixed, and cost varies widely.
Simple habits cut your risk. Keep feet dry; change socks daily; choose breathable shoes; rotate shoes so they dry between wears. Don’t walk barefoot in public pools, locker rooms, or showers. Trim nails straight across and file thickened areas to reduce fungal load. Disinfect nail clippers and avoid sharing them.
If you have athlete’s foot (scaly, itchy skin between toes), treat it too—skin fungus often spreads to nails. For people with diabetes or poor circulation, seek care early; nail infections can lead to bigger problems.
Home remedies like tea tree oil or Vicks are popular, but studies show limited benefit. If you try them, use them alongside proven methods and stop if irritation appears. Expect treatment to take time: toenails can need 6–12 months to look normal as new clear nail grows in.
If a nail is painful, growing worse, or you have risk factors like diabetes or liver disease, see a doctor sooner rather than later. With the right diagnosis and a treatment plan, most people clear the infection and keep their nails healthy again.
Apr, 9 2025
In 2025, those looking for terbinafine alternatives have a variety of options for treating fungal infections. One such option is Amorolfine 5%, which is effective for certain types of nail infections and requires only a weekly application. While Amorolfine isn't approved in the U.S., it's a practical choice elsewhere and is notable for its non-invasive use. This article will provide an overview of Amorolfine among other options, weighing their pros and cons to provide clarity and guidance to those exploring their choices.