Toenail Fungus Treatments: Pills, Prescription Polishes and Lasers Compared

Thick, yellowed or crumbly toenails become more common with age, and sandal season can make them feel urgent. Drugstore liquids, home remedies and laser spa packages all promise clearer nails. Here is what the American Academy of Dermatology (AAD)¹ says works, and how the options compare.

First, make sure it’s fungus

The AAD says testing is sometimes needed to diagnose nail fungus and treat it well.² A dermatologist will look at your fingernails and toenails, ask about your health and possible exposures, and may clip or scrape a sample to test.¹ Other nail problems can look similar, and treating the wrong one wastes time and money.

What doesn’t clear it

Scraping or filing away the buildup won’t cure the infection, because the fungus also lives in the nail and the tissue underneath.² The AAD says clearing a fungal nail infection takes prescription medicine.²

The prescription options

Option	How it’s used	How long
Terbinafine pills	One pill a day	12 weeks for toenails, 6 for fingernails1
Efinaconazole solution	Applied daily at home	Usually 48 weeks1
Tavaborole solution	Applied daily at home	Usually 48 weeks1
Ciclopirox nail lacquer	Applied daily, removed weekly with rubbing alcohol	Often with regular nail trimming1

Pills work for more widespread infections. Before terbinafine, you’ll need a liver test, repeated about six weeks in. Liver damage is rare but possible. The AAD also advises avoiding alcohol and sun while you take it.¹

Topical solutions must be used every day for as long as prescribed, even if your nail starts to look better.¹

What about lasers?

The AAD says the FDA hasn’t approved any laser to treat nail fungus. Lasers are approved to improve the look of a nail after the infection has cleared. Insurance usually considers that cosmetic and doesn’t cover it.¹ If a clinic offers a laser package to “cure” fungus, ask what else is included.

Expect a long wait for a clear nail

Even after the infection clears, the damaged nail has to grow out. On a big toe, a clear nail can take a year or longer.² Some people with diabetes, circulation problems or a nail injury may need ongoing treatment to keep infection from returning.¹

Questions to ask

1. Can we confirm it’s fungus before starting treatment?
2. Which option fits my health and medicines, including my liver and any drug interactions?
3. What will my insurance cover, and is there a generic?
4. Can I wear nail polish during treatment?¹

Try: “My big toenail has been thick and yellow for a year. Can we test it to confirm fungus, and would a pill or a topical solution be better for me?”

Skin, Head to Toe includes a short-shelf planner and a 12-week SkinLog. Use them to track daily treatments and take monthly photos of your nails, so you can see progress as they grow out. See the book.