Toenail Fungus Treatment Options in Canada: An Overview

If you've been told you have toenail fungus, or you suspect it, you'll quickly find a long list of possible treatments. This article gives you a neutral overview of the main categories available in Canada, with general pros and cons, so you can have a better-informed conversation with your pharmacist, family doctor, nurse practitioner, podiatrist, chiropodist or dermatologist.

We don't prescribe or recommend any particular treatment, and this isn't a substitute for advice from a healthcare provider. The right choice depends on your health, your other medications, how many nails are affected, how severe the infection is, and the type of fungus involved.

Step zero: confirm it's fungus

Before any treatment, it helps to know you're treating the right thing. Nail trauma, psoriasis and other conditions can look like fungus, and antifungal treatments won't help them. The NHS notes that before prescribing antifungal tablets, a doctor might test a nail sample, and the American Academy of Dermatology (AAD) says a nail sample helps make sure you have nail fungus. You can read more in why you should test before treating.

Oral prescription antifungals

These are tablets prescribed by a doctor or nurse practitioner (and, in some provinces, other prescribers for certain conditions). They work from the inside, reaching the nail through the bloodstream.

General pros:

• Often considered for more extensive infections, or when several nails are involved.
• Usually taken for a shorter time than topical treatments, typically a few months. The nail still takes much longer to grow out.

General cons:

• Possible side effects. The NHS lists headaches, an itchy rash, stomach ache, feeling sick and diarrhoea among them.
• They aren't suitable for everyone, for example people with certain liver or kidney conditions, and some interact with other medications.
• Your prescriber may order blood tests to check your liver before or during treatment.

Topical prescription nail solutions

These are liquids or lacquers applied directly to the nail and surrounding skin, usually daily, for a long period. The AAD notes that some prescription topical treatments are used for close to a year.

General pros: fewer whole-body side effects than tablets, and an option for people who can't take oral antifungals. The AAD notes topical treatments may be prescribed for mild, and sometimes moderate, infections.

General cons: they must be applied consistently for many months, they can struggle to get through a very thick nail, and a provider may suggest thinning the nail to help the medication penetrate. Skin irritation around the nail can occur.

Over-the-counter (pharmacy) products

Pharmacies sell a range of non-prescription antifungal creams, sprays, liquids and nail products. Some are designed for athlete's foot on the skin rather than for infections inside the nail, so it's worth reading the label carefully and asking the pharmacist. The NHS describes pharmacy antifungal nail medicines that need to be used for 6 to 12 months before the nail may improve.

General pros: easy to get, and may suit mild infections or help with athlete's foot on the surrounding skin.

General cons: limited ability to reach fungus under a thick nail, and long-term daily use is needed. Our article on over-the-counter nail fungus products explains what they can and can't do.

Laser and light-based treatments

Some clinics offer laser treatment for nail fungus. It's usually not covered by public health insurance and can involve several sessions.

General pros: no medication to take, and few side effects for most people.

General cons: research is still developing and the cost can be significant. The AAD notes that in the United States, lasers are approved to improve the look of a nail after the infection has cleared, not to treat the infection itself, and that while early studies show promise, well-designed trials are still needed. Ask the clinic what evidence supports the treatment and what happens if it doesn't work.

Nail debridement and removal

Debridement means thinning or trimming a thick, infected nail. A podiatrist, chiropodist or other provider can do this to make the nail more comfortable and help topical treatment penetrate. It's often used alongside other treatments.

Nail removal may be considered for severe or painful infections, or when other treatments haven't worked. The NHS describes it as a small procedure done under local anaesthetic. The AAD notes a toenail can take 12 to 18 months to grow back.

Home remedies

Many people try vinegar soaks, tea tree oil and other home remedies. The evidence for these is limited. We look at what's known in home remedies for toenail fungus: what the evidence says.

Things that affect any treatment

• Time. All treatments take months, and the nail grows out slowly. See how long treatment takes.
• Consistency. Stopping early because the nail "looks better" is a common reason treatment fails.
• Reinfection. Untreated athlete's foot, damp shoes and shared nail tools can bring it back. See how to prevent toenail fungus.
• Your health. Diabetes, circulation problems, pregnancy or breastfeeding, and other medications all affect which options are suitable.

Questions to ask your healthcare provider

1. Has the cause been confirmed as fungus?
2. Which treatment options suit my health and medications?
3. How long will I need to use it, and how will we know if it's working?
4. What side effects should I watch for?
5. What can I do to lower the chance of it coming back?

Start with a clear answer

Every option above takes months of time and effort, so it makes sense to confirm fungus is involved first. Our at-home kit checks a nail clipping for fungal DNA using qPCR testing. Every result is reviewed by a licensed Canadian podiatrist with over 50 years of experience, and your report arrives 4–14 days after your sample reaches us, ready to share with whoever helps you decide on treatment. See our sample report and guide to understanding your results.

Frequently asked questions

What is the most effective treatment for toenail fungus?

There isn't one best treatment for everyone. A healthcare provider considers how many nails are affected, how severe the infection is, the type of fungus, your health and your other medications. Confirming that fungus is actually present is a sensible first step.

Do I need a prescription to treat toenail fungus in Canada?

Some antifungal products are available without a prescription at pharmacies, while oral antifungal tablets and some nail solutions need one. A pharmacist can explain what's available and whether you should see a doctor or nurse practitioner.

Is laser treatment for toenail fungus covered in Canada?

Laser treatment is generally offered by private clinics and is usually not covered by provincial health plans. Some private insurance plans may differ, so check with your insurer and ask the clinic about costs and evidence before starting.

Why do toenail fungus treatments take so long?

Treatment has to clear the fungus from inside and under the nail, and then the damaged nail has to grow out. Toenails grow slowly, so it can take a year or longer to see a fully normal nail.

Should I get tested before starting treatment?

Many healthcare providers prefer to confirm a fungal infection before prescribing, because other conditions can look the same. A nail test can save you from spending months on a treatment that can't work.

Sources

• American Academy of Dermatology: Nail fungus diagnosis and treatment
• NHS: Fungal nail infection
• Mayo Clinic: Nail fungus, diagnosis and treatment
• Canadian Dermatology Association: Nail fungus and infection