Over The Counter Fungal Remedies
Many people don't have the option to use systemic antifungal treatments because of the drug toxicity. Fortunately, simple, every day debris removal has been shown to be a key factor in curing fungal infection in nails. The placebo topical product used on fungal nails in the study by Gupta et al. (2022) still worked to cure fungal infections even though there was no antifungal drug in the product. The products included ingredients such as urea and lactic acid, which are categorized as humectant emollients.
Humectant emollients work by bringing water to the top layer of the skin either from the atmosphere or deeper layers of the skin. Alternatively, occlusive emollients like oils, waxes, dimethicone, and petrolatum form a barrier that prevents water loss from the skin. Bringing water into dead skin buildup or fungal debris will soften it for easy removal. Removing the debris removes fungus with it.
Vick's VapoRub contains ingredients that will soften debris for removal and may slow/stop the build up of fungal debris. It is an occlusive emollient with petrolatum and oils, a couple of which are permeation enhancers, allowing for deeper penetration. Below is a breakdown of the ingredients with other options for antifungal applications.
Vick's VapoRub Ingredients
Vick's VapoRub has a history of being used off-label for fungal nails. The ingredients discussed in studies include thymol, menthol, camphor, and Eucalyptus oil (Ramsewak et al., 2003; Derby et al. 2011). These ingredients are found in the essential oils of certain plants in varying percentages.
When using phytochemicals in essential oils as antimicrobials and antifungals, treat them as you would an antibiotic. Orchard & van Vuuren (2017) warns that resistant strains can emerge when used in concentrations that aren't enough to inhibit growth. In the studies by Derby et. al (2011) and Ramsewak et al. (2003), subjects used Vick's Vaporub (or Meijer™ medicated chest rub) once a day, always including the base of the toenail.
According to the Vick's website, the ingredients of Vaporub are listed as follows:
Eucalyptus Oil 1.2%
Menthol 2.6 %
Ramsewak et al. (2003) reported that camphor, menthol, thymol, and Eucalyptus oil were the most effective ingredients, however the other ingredients play a part as well.
Camphor is found in lavender, Russian sage, rosemary, and yarrow (Orchard & van Vuuren, 2017). Cedar leaf oil also contains camphor, which acts as an antibiofilm and a permeation enhancer (Manoharan et al., 2017; Kreutz et al., 2019).
1,8-Cineol is the primary antifungal phytochemical found in eucalyptus, and can be found in other plants, including lavender, peppermint (Mentha piperita), myrtle, basil (Ocimum americanum), Russian sage, sage (Salvia ringens), rosemary, and thyme (Thymus mastichina) (Orchard & van Vuuren, 2017). 1,8-Cineol inhibits germ tube formation in fungus (Pina-Vaz et al., 2004).
Thymol is found in oregano and thyme (Orchard & van Vuuren, 2017). Thymol contributes to destroying the fungal cell membrane (Pina-Vaz et al., 2004). Thymol paired with 1,8-cineole (found in eucalyptus oil) synergistically work together against fungus (C. albicans) (Orchard & van Vuuren, 2017; Pina-Vaz et al., 2004).
Menthol is found in peppermint (Mentha piperita) and is an antifungal (Orchard & van Vuuren, 2017). Menthol (peppermint oil) and turpentine (pine oil) have been used as permeation enhancers (Kreutz et al., 2019).
Orchard & van Vuuren (2017) reported that Soković et al. (2009) found peppermint (menthol) and thyme (thymol and p-cymene) to be safe and effective against M. canis, E. floccosum, T. rubrum, T. mentagrophytes, T. tonsurans. Thymol paired with p-cymene synergistically work together against fungus (C. albicans) (Pina-Vaz et al., 2004).
Nutmeg Oil inhibits bacterial growth (D'Souza et. all, 2017).
Petrolatum is used as a base for the oils, but also acts as an occlusive emollient, which seals in moisture. Keeping skin cells hydrated and the spaces between the skin cells sealed with oils will enhance skin's natural protective barrier. However, maceration can occur with skin-to-skin contact, so consider wearing toe-socks or avoiding putting petrolatum between your toes.
Goals of an Antifungal Agent
After breaking down Vick's VapoRub, we can consider the goals of an antifungal agent, all of which VapoRub meet. The ideal antifungal for nails would be something that is:
2. Not significantly toxic
3. Allows the chemical to permeate from the nail plate down to the nail bed
4. Reduces the biofilm that protects the fungus
5. Attacks the fungus in multiple ways
How to Use Vick's on your Toenails
In the Vick's VapoRub study by Derby et al. (2011), 15 out of 18 subjects had positive results. In the study by Ramsewak et al. (2003) with Meijer™ medicated chest rub (same ingredients as Vick's), the compliant subjects showed improvement by 2 months and clear toenails by 5-16 months. Both studies instructed the subjects to apply the ointment to their toenails, including the base of the nail, once a day. Nighttime is best and without socks (feet should be able to move/breathe/air out at night). Darker colored sheets may show the oil and staining will depend on the material of the sheet.
Never do anything that causes pain. If anything hurts or looks infected, stop using these products and see a foot care professional.
Soft fungal debris will need to be removed before applying Vick's VapoRub. Without removal of the debris: 1) more debris will form and 2) the nail plate cannot reattach to the nail bed. The best way to remove the debris is to use a soft bristled tooth brush and soap and water on and around the nail. If the debris goes far under the nail plate, remove the debris with a small, blunt file. Do not separate the nail plate from the nail bed.
If it is soft, then it doesn't belong on your nail. Any part of the nail that comes off in bits or chunks is diseased nail or fungal debris.
110%: Other things you can do to rid yourself of fungus include:
- Wear clean socks every day, even if they look and smell clean after minor use.
- If your socks get sweaty, try a synthetic or wool blend, which will wick away moisture.
- Wash your shoes regularly if you don't wear socks.
- Wash your feet at the end of the day, every day.
- Take your inserts out of your shoes for drying overnight and replace before wearing.
- Rotate your shoes so you don't wear the same pair two days in a row.
- Wear sandals/flipflops in public pools/showers.
- Don't use nail polish.
Bonus use: Vick's VapoRub can be used on calluses/corns.
Step 1: Wash your feet to remove debris/dead skin and add water to your skin.
Step 2: Towel dry, especially between the toes.
Step 3: Moisturize with a non-irritating lotion, like Aveeno Daily Moisturizing Lotion.
Step 4: Apply a thin layer of Vick's VapoRub to the callus/corn, avoiding between the toes.
Repeat these steps every day to exfoliate calluses/corns.
Feeling adventurous? Instead of soap when brushing the nails, try Arm & Hammer Essentials Baking Soda toothpaste. Baking soda has been found to slow the growth of certain fungi and the peppermint oil is a permeation enhancer, as well as an antifungal agent.
Mentha piperita, Lavandula augustifolia, Thymus vulgaris
Creating Your Own Antifungal Essential Oil Mix
If you are avoiding petroleum products, you can create your own essential oil mixture based on the Vick's VapoRub ingredients.
This recipe theoretically contains a portion of the phytochemicals found in Vick's VapoRub, which has been studied and determined to be effective against fungal nail infections (Derby et al., 2011; Ramsewak et al., 2003). Instead of petrolatum, this recipe calls for olive oil, an anti-Candida agent (Goel et al., 2016). These essential oils have not undergone gas chromatography and the percentage of phytochemicals is unknown.
Directions for use: Once a day, apply 1-2 drops to each toenail. Flood into the the nail groves, the front of the nail, and under the nail.
(2% dilution = 18 drops essential oil per 6 teaspoons carrier oil)
Essential oil: English lavender oil (Lavandula angustifolia)*
Use: antibiofilm and permeation enhancer
Use: inhibits germ tube formation
Amount: 6 drops
Essential oil: Peppermint oil (Mentha piperita)**
Use: antifungal/permeation enhancer
Amount: 6 drops
Essential oil: Thyme oil (Thymus vulgaris)***
Phytochemical: Thymol, p-cymene
Use: destroys fungal cell membrane
Amount: 6 drops
Carrier oil: Organic, cold-pressed, extra virgin olive oil
Use: antifungal from acidity percentage
Amount: 6 teaspoons
Container: Dark glass (plastic may react to essential oils) stored in a cool and dark place.
*[English] lavender (Lavandula angustifolia) contains 1,8-cineole and camphor and works against T. erinacei, T. mentagrophytes, T. rubrum, T. schoenleinii, T. soudanense, and T. tonsurans (Cardia et al., 2018; Orchard & van Vuuren, 2017)
**Peppermint (Mentha piperita) contains menthol and works against M. canis, E. floccosum, T. rubrum, T. mentagrophytes, T. tonsurans (Orchard & van Vuuren, 2017).
***Thyme (Thymus vulgaris) contains thymol and p-cymene and works against M. canis, E. floccosum, T. rubrum, T. mentagrophytes, T. tonsurans (Orchard & van Vuuren, 2017).
DISCLAIMER (a.k.a Snake Oil Warning): This recipe has not been evaluated by the Food and Drug Administration. The products you may or may not purchase are not intended to diagnose, treat, cure, or prevent any disease. Keep out of reach of people who cannot be responsible with essential oils. Avoid contact with eyes, nose, mouth, and open wounds. For external use only. If you are pregnant, nursing, or under a doctor's care, consult your physician.
Cape Cod Foot Care is not a professional compounder or pharmaceutical company, but will try to get you the most useful and relevant evidence-based information possible. This recipe is intended for toenails and toes only. Consider using plain olive oil for your fingernails. Creating your own essential oil mix is for experienced Mixers only or those who will be cautious with the mixing and use of essential oils. Do not use essential oils without dissolving in a carrier oil and thoroughly mixing. Do not use essential oil mixes if your skin is typically sensitive. Do not use on non-intact skin (wounds). Test on one nail to determine skin sensitivity before regular use. If you experience skin sensitivity, discontinue application or dissolve with additional carrier oil, and retest your sensitivity before regular use.
Cardia, G., Silva-Filho, S. E., Silva, E. L., Uchida, N. S., Cavalcante, H., Cassarotti, L. L., Salvadego, V., Spironello, R. A., Bersani-Amado, C. A., & Cuman, R. (2018). Effect of Lavender (Lavandula angustifolia) Essential Oil on Acute Inflammatory Response. Evidence-based complementary and alternative medicine: eCAM, 1413940. https://doi.org/10.1155/2018/1413940
Derby, R., Rohal, P., Jackson, C., Beutler,A., Olsen, C. (2011, January). Novel Treatment of Onychomycosis using Over-the-Counter Mentholated Ointment: A Clinical Case Series. The Journal of the American Board of Family Medicine, 24(1) 69-74; https://www.jabfm.org/content/24/1/69.full
D'Souza, S. P., Chavannavar, S. V., Kanchanashri, B., & Niveditha, S. B. (2017). Pharmaceutical Perspectives of Spices and Condiments as Alternative Antimicrobial Remedy. Journal of evidence-based complementary & alternative medicine, 22(4), 1002–1010. https://doi.org/10.1177/2156587217703214
Gupta, A. K., Venkataraman, M., Quinlan, E. M., & Bamimore, M. A. (2022). Cure Rates of Control Interventions in Randomized Control Trials of Onychomycosis Treatments. Journal of the American Podiatric Medical Association, 112(6), 20-226. https://japonline.org/view/journals/apms/112/6/20-226.xml
Goel, N., Rohilla, H., Singh, G., & Punia, P. (2016). Antifungal Activity of Cinnamon Oil and Olive Oil against Candida Spp. Isolated from Blood Stream Infections. Journal of clinical and diagnostic research : JCDR, 10(8), DC09–DC11. https://doi.org/10.7860/JCDR/2016/19958.8339
Kreutz, T., de Matos, S. P., & Koester, L. S. (2019). Recent Patents on Permeation Enhancers for Drug Delivery Through Nails. Recent patents on drug delivery & formulation, 13(3), 203–218. https://doi.org/10.2174/1872211313666191030155837
Manoharan, R. K., Lee, J. H., & Lee, J. (2017). Antibiofilm and Antihyphal Activities of Cedar Leaf Essential Oil, Camphor, and Fenchone Derivatives against Candida albicans. Frontiers in microbiology, 8, 1476. https://doi.org/10.3389/fmicb.2017.01476
Orchard, A., van Vuuren, S. (2017). Commercial Essential Oils as Potential Antimicrobials to Treat Skin Diseases. Evidence-Based Complementary and Alternative Medicine, Article ID 4517971. https://doi.org/10.1155/2017/4517971
Pina-Vaz, C., Gonçalve, A. (2004). Antifungal activity of Thymus oils and their major compounds. Journal of the European Academy of Dermatology and Venereology, 18, 73–78. https://doi.org/10.1111/j.1468-3083.2004.00886.x
Ramsewak, R. S. Nair, M. G., Stommel, M., & Selanders, L. (2003). In vitro Antagonistic Activity of Monoterpenes and Their Mixtures Against ‘Toe Nail Fungus’ Pathogens. Phytotherapy Research, 17, 376–379. DOI: 10.1002/ptr.1164
Soković, M. D., Vukojević, J., Marin, P. D., Brkić, D.D., Vajs, V., Van Griensven, L. J. L. D. (2009). Chemical Composition of Essential Oils of Thymus and Mentha Species and Their Antifungal Activities. Molecules, 14(1), 238-249. https://doi.org/10.3390/molecules14010238