Only 2.5 million people are treated for toenail fungus or treated to cure ugly toenails, but over 30 million people have the fungus infection.  Fungal infections ARE contagious and can spread from toe to toe and body to body.

After over 11+ years of practice, fungal toenails have been the most common diagnosis in my practice and I’m sure I speak for 99% of the podiatry world.  However, just because you have discolored, thick, ugly, “fungal-looking”, toenails, doesn’t mean you have fungus in your toenails. Remember the funny commercial for Lamsil with the crazy looking Digger animal?  That was the beginning of the treatment trends for fungus in the world of podiatry.  Of course there were Sporanox and Gris-Peg, but these were oral medications just like Lamisil that were harsh on the liver and could only be used for skin conditions and not for treatment of toenails.  I still routinely use Gris-Peg for oral treatment for SKIN fungus that is very severe, but it is used for only 2-4 weeks, not 3 months like Lamisil is used.

Please remember, that no, I mean NO, one topical medication works 100%.  If someone told you that, they are LYING to you.  Noticed on all the link that I provide that not one topical medication that treats or cures ugly toenails, will advertise that they cure or remove fungal toenails.  The say words like decrease, normalize, reduce, soften, restore, etc.  Also know that NO studies or trials have been officially done to show complete resolve of the fungal infection in the toenail.

Also note that all topical medications, in order for them to work effectively, you MUST file down the nail at least once a week and use the medication for at least six months.  There three categories of topical medications that can treat or cure ugly toenails:

  1. OTC (over-the-counter)
  2. Physician only OTC
  3. Prescription only

These categories can be sub-categorized by medications that treat fungus and medications that treat thick, discolored and dysthrophic nails.  These are 2 completely different problems and are treated with completely different medications.

OTC (over-the-counter) Topical medications:

These medications are only for non-fungal nails and nails that are thick, discolored or dystrophic (softens nail only):

This is a prescription medication that also has a rebate offer for those of us that have high copays for medications.  This medication is mainly only used for NON-Fungal nails. Basically, if you see your doctor and they tell you that you don’t have a fungus but your nail is discolored and dysthropic or thickened, then this medication is for you.  Your doctor will need to send a piece of your nail to the lab to check for fungus using a KOH test.

Kera Nail Gel
This topical is a high-potency nail treatment in a vehicle containing, Tea Tree Oil, Menthol, Camphor and Eucalyptus Oil.  Tea Tree Oil is one of many home remedies that help treat fungal toenails.

Kerasal nail
I’ve seen this sold online and at Walmart for between $19.00 to $33.00.  There is NO active antifungal ingredient in this medication.  Basically, its main ingredients are skin softeners like lactic acid and urea.  So if you are trying to cure ugly toenails, then this medication will be least effective.  It will be more effective as an adjuctive treatment with an additional topical medication with an anti-fungal medication in its formula.  Also use with laser treatment can help too.

Topical treatment for fungal nails:

One of the few topical medications that use an old fashion antifungal called Clotrimazole for broad-spectrum coverage.  Clotrimazole is also known by the brand name Lotrimin which is used for athletes foot infections.  As the name as its spelled on the end “-oil” has an added essential oil in the formula as a carrier to help penetrate into the toenail.  Formula 3 also has this using Jojoba oil as I will mention below.

This medication is also an in-office dispense medication and can not be purchased from a retail store.

Formula 3
Formula 3 was the first product available to patients utilizing this formulation which includes natural JOJOBA OIL. The jojoba oil is quickly absorbed by the skin, which delivers the tolnaftate directly to the infected area.  Because jojoba is virtually identical to sebum — the oil people’s skin produces naturally– the tolnaftate in Formula 3® Antifungal quickly and effectively penetrates the skin, speeding healing to the infected areas.

This is the first topical anti-fungal treatment that began the money back guarantee to podiatry offices for there patients who purchased the product.  With the development of many new types of anti-fungal medications, Formula 3 is no longer the top one on the market, although it is still widely used and about 20-30% effective, based on my patient’s information.  Although, most topical anti-fungal medications for cure ugly toenails (treat is the better word since there is no cure) is less than 10% across the board.

Please be aware that the main ingredient, tolnaftate, is not FDA approved for toenails and only approved for skin conditions such as athletes foot and ringworm.

Molecular AF
Molecular AF™ Dynamic Oil combines Tolnaftate 1% and complementing natural anti-fungal ingredients. Our applicator brush targets the source of fungal infections in, around and under the infected area.  This medication also is a physician in office dispense only.  Not prescribed through a pharmacy.   Cost is around $40 per bottle.

This medication is, again, very similar to formula 3 and DermaTAF.  They all use Tolnaftate and other additional natural ingredients.  Basically, this differs in the other ingredients.  They all have the same 50%-60% success rate but don’t forget in order for these topicals to be successful in treating or curing ugly toenails, you have to use additional measures such as filing, laser treatments, softening agents, twice a day use, 6+ months of use, etc.

Mycocide Clinical NS
Not sure if I’d use this product only because their website didn’t tell me the active ingredient and some of their links were not working (a sign of poor business management).  Although, on the positive side, it does come with 2 coarse nail files, which is one of the most important things in helping cure ugly toenails.  You can buy this at any local pharmacy retail store.  Cost $10-$20 per 1 oz bottle.

This medication is only dispensed by a certified physicians or podiatrists that treat nail fungus.  Not all podiatrists supply this medication.  Cost is usually around $40 per bottle and each bottle will last between 6-12 months depending on how many toenails are treated.  The main ingredient is 0.5% Polyhexamethylene Biguanide (PHMB).  Something that reserves me from giving my 100% approval to this medication is the PHMB is only an antiseptic and not antifungal.  Some studies (Hohaus K, Vennewald I, Wollina U. Deep mycosis caused by Trichophyton mentagrophytes in a diabetic patient. Mycoses. 2003;46(8):355-357.) have shown it to help with fungus for oral use with an additional mixture of other antifungals, but not PHMB by itself.  This medication is FDA registered and approved for use on the nails.  Most topical medications are not approved for nails only skin.  This medication has no contraindications, no sensitivity and no allergies.  It also has a money back guarantee.  This medication is actually a gel so it will penetrate better than a solution and soften the nail also.

Penlac (Ciclopirox Nail Lacquer 8%)
This one was the first topical medication out in the market that was FDA approved for treating toenail fungus.  It is now a generic brand and works about the same as most other topical medications.  The problem we had with this one, was that is formed a hard sticky lacquer after each application that had to be filed down once a week.  The good thing is that it is still available and can be prescribed by a physician and no out of pocket cost with the in office dispense although if your insurance has a high copay it might not be worth it.

Jublia (efinaconazole) 10% solution
This is the newest topical medication that is added to the market that is only available via prescribtion from a podiatrist or your medical primary care doctor.

Keradyn (tavaborole) solution 5%
KERYDIN® is a topical prescription for the treatment of toenail fungus. It’s the first and only treatment in a new class of antifungals that uses boron technology. Boron-based molecules are very small. Their size and shape contribute to their ability to reach the site of infection. This helps KERYDIN® to get to the root of toenail fungus. KERYDIN® comes with a dropper application that gets the medication to where it needs to go.
Here is a option for patients for a coupon to get a discount on the medication.

Topical antifugal with color nail polish added:

Dr. Remedy
One of the few topical medications that is completely safe and is a type of nail polish with different colors offered. This blend includes: wheat protein, tea tree oil, garlic bulb extract and lavender. Dr.’s Remedy is the best alternative nail care line for anyone who wants beautiful looking nails and wants to avoid formaldehyde, formaldehyde resin, toluene and DBP. Dr.’s Remedy is vegan friendly and utilizes a range of organic ingredients.

This medication does not have any chemical that provides anti-fungal properties but it does have Tea Tree Oil that has some anti-funugal properties to help fight and cure ugly toenails.  One of the things I like about this medication is that it was developed by 2 podiatrists.  If you are looking for pretty nails and not as concerned about fungus or curing ulgy toenails, then this is for you.  This might be a good choice for a female that wants to paint their nails for a special occasion and still be treating the diseased nail at the same time.

DaniPro Nail polish
Very Similar to DrRemedy.  Very safe medication and has mild antifugal properties by being infused with an all-natural additive called undecylenic acid.  Noted for its different colors available to polish your toenails and provide antifungal treatment at the same time.  Can be purchased online or at selected doctors offices.  Cost about $17-$25 for 1/2 oz bottle.  Read this article about how this nail polish can cure ugly toenails.

See this personal video on how to properly apply the topical medication to your toenails to help cure ugly toenails.


Dr. Dennis M. Timko

Dr. Dennis M. Timko


Dr. Dennis Timko, is a podiatrist in the St. Louis, Eureka, MO. area. Dr. Timko specializes in diabetic foot care, foot surgery, AFOs, and orthotics. Dr. Timko is the solo owner of Arch City Foot & Ankle, which has been in business since 2003.