Antifungal Nail Polish Names for Toenail Fungus
The primary antifungal nail polishes (lacquers) available for treating toenail fungus are amorolfine and ciclopirox, with efinaconazole being a newer option. 1
Main Topical Antifungal Lacquers
Amorolfine (Loceryl)
- Available as 5% nail lacquer applied once or twice weekly for 6-12 months 1
- Achieves approximately 50% effectiveness in distal fingernail and toenail onychomycosis 1
- Once-weekly application is as effective as twice-weekly application 1
- Side effects are rare and limited to local burning, pruritus, and erythema 1
Ciclopirox
- Available as 8% nail lacquer applied once daily for up to 48 weeks on toenails (24 weeks on fingernails) 1, 2
- Achieves 34% mycological cure versus 10% with placebo 1, 2
- Cure rates are usually lower with ciclopirox compared to amorolfine, though no direct head-to-head trials exist 1, 2
- Most common side effects are periungual and nail fold erythema 1, 2
Efinaconazole
- Available as 10% topical solution applied once daily 1
- Achieves mycological cure rates approaching 50% and complete cure in 15% of patients after 48 weeks 1
- Experts recommend efinaconazole as first-line for mild-to-moderate onychomycosis due to enhanced nail penetration 3
Tioconazole
- Available as 28% solution 1
- Lower efficacy with only 22% mycological and clinical cure 1
- Allergic contact dermatitis is not uncommon 1
Important Clinical Considerations
Clinical improvement does not equal mycological cure - cure rates are often 30% lower than apparent clinical improvement with topical antifungals 1, 2
Topical therapy is appropriate only for:
- Superficial white onychomycosis 2
- Early distal lateral subungual onychomycosis when <80% of nail plate is affected without lunula involvement 1
- When systemic antifungals are contraindicated 1
The nail plate acts as a significant barrier - drug concentration can drop 1000-fold from outer to inner nail surface 1