How to Treat Toenail Rot in 2008

Before you read any further, if you haven't done so already, please read our article entitled, "Toenail Rot: Nail Fungus and How to Treat It." That article is a good, clear introduction to the topic of "rotting nails" and will make it much easier to make practical use of the information contained in this article.

If you're still reading, you most likely know what toenail rot looks like, and you should know that it is caused by a fungus infection growing under your nails. You also should have learned that it can be far more serious than merely a cosmetic problem. So, if you have decided to do something about it, keep reading.

Treatments for toenail rot (nail rot, rotting nails, nail fungus or onychomycosis) include both natural and pharmaceutical and both topical and systemic (topical refers to something you apply to the outside of your body and systemic refers to something you take internally by injection or by swallowing pills). Recent studies show that certain natural nail fungus treatments can be highly effective. Here is a run-down of your options as of 2008:

Pharmaceutical Treatment - Systemic

There are two main products available by prescription that are taken orally, Lamisil and Sporanox. Lamisil (chemical name, terbinafine; chemical class, allylamine) is made by the pharmaceutical company, Novartis. Sporanox (chemical name, itraconazole; chemical class, triazole) is made by the Janssen-Ortho Inc. subsidiary of the pharmaceutical company, Johnson & Johnson. These two products are direct competitors, and the medical literature is not clear on which one is superior. Neither of them works all the time, and for many people they will not work at all, so it is good to be aware that you have choices.

Very importantly, both prescription medications can cause serious side effects. The FDA issued a Public Health Advisory on Lamisil and Sporanox on May 9, 2001. That document is available here: If you have heart problems or liver problems you should be especially careful with these drugs and make sure both you and your doctor fully understand the risks of using them.

You may find it interesting, if you are somewhat technically inclined, to read the position statement of the insurance company, CIGNA HealthCare, updated near the end of 2007 and available here: pharmacycoverageposition_onychomycosis_antifungals.pdf. In particular, notice the requirements they have for insurance coverage--more than merely a confirmed diagnosis of a fungal nail infection. They also require that you experience pain associated with the infection. Perhaps this is not surprising since they are in this business for the money, and the more restrictive their requirements are the less money they will pay out for treatment. But, you should clearly understand that if you have toenail rot, it makes no sense to wait to start treatment until you are feeling pain. The infection is there whether it hurts or not, and it won't go away by itself. In general, the earlier you can begin treatment of an infectious disease, the better your chances of a cure.

Pharmaceutical Treatment - Topical

The primary prescription treatment for toenail rot that is used topically is Penlac (chemical name, ciclopirox) made by the pharmaceutical company Sanofi-Aventis. This product is a nail lacquer that is applied directly to the affected nail each day. The main advantage of this treatment over the oral medication is that there are very few side effects and the product is much safer for anyone who has heart or liver problems. On the other hand, the cure rate is lower. Some reports suggest that only about 10 percent of people can be cured of toenail rot with topical products, whereas the oral medication has a cure rate of 30 percent and higher.

Natural Products

There are many natural products and remedies promoted for treating nail rot. Some of these work for some people, but few of them work for serious cases. Be careful and do your homework carefully before spending money and time on these products, and if you do not see results after a few months of use, consider talking to a doctor about a prescription for stronger medicine.


Peruse our site and look through our articles to see if we can help you with your health questions. Remember, though, that only your healthcare professional can diagnose and recommend specific treatments for your health issues. We are here to give you a knowledge base that you can use to better understand your doctor's orders and to help you know what questions to ask.