Fungal infections of the nails (onychomycosis) typically do not get better with over-the-counter products. These products are generally effective in only a small percentage of people who use them.
The first step in approaching abnormal toenails is determining the cause of the problem. Only about half of the time are toenail abnormalities the result of a nail fungal infection. Other causes include psoriasis of the nails, nail damage caused by trauma and autoimmune disorders. It is important to see a dermatologist to determine the underlying cause of the problem before deciding to embark on a course of treatment.
For fungal infections of the nails, the most effective treatment is an oral anti-fungal medication. The medicine that has the highest cure rate is called terbinafine. This medicine cures the infection in about 75% of cases. Terbinafine is usually safe but has some uncommon side effects, and so blood tests are required before starting it and while on this medication.
A new prescription anti-fungal topical solution called efinaconazole became available in Canada last year. Although not as effective as Terbinafine, Efinaconazole is a good option for people who have mild infections and/or who don't want to take an oral medication.
If you think you may have a fungal infection of your nails, consider speaking to a dermatologist about your options.