Fungal Nails

Information about OTC antifungal remedies.

Over The Counter Fungal Remedies

Many people don't have the option to use systemic antifungal treatments because of the drug toxicity. Vick's VapoRub may be used off-label for fungal nail infections. Below is a breakdown of the ingredients with other options for antifungal applications.

 
Vick's VapoRub
 
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 toe nail.

According to the Vick's website, the
ingredients of Vaporub are listed as follows:
Camphor 4.8%
Eucalyptus Oil 1.2%
Menthol 2.6 %
Cedarleaf Oil
Nutmeg Oil
Petrolatum
Thymol
Turpentine Oil




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 inhibits bacterial growth (D'Souza et. all, 2017).

Petrolatum is used as a base for the oils, but also acts as a humectant, which attracts and retains water to rehydrate dry skin. 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:

1. Affordable
2. Not significantly toxic
3. Allows the chemical to permeate the nail 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 ointments to their toes, including the base of the nail, once a day. In addition to application once a day, please consider additional steps to inhibit fungal growth.


Additional Steps to Inhibit Fungal Growth
Socks made with synthetic materials will wick away moisture better than cotton or wool. Consider changing your socks more than once a day. If you get sweaty feet and don't want an anti-perspirant, consider toe socks to avoid skin-to-skin contact.

Shoes must be breathable and dried out after use. Consider giving your shoes every other day off or use a shoe dryer so they can dry out.

Nail clippers should be washed with soap and water and allowed to dry thoroughly (and ideally disinfected) between each use. Avoid sharing nail clippers.

Debris from fungus builds up, so designate a toothbrush as your nail brush, and clean your nails, nail grooves, between your toes, and under your toes with soap and water at the end of your day. Thoroughly dry between your toes, under your toes, and your nail grooves.



Creating Your Own Antifungal Essential Oil Mix
This recipe has not been studied, but may theoretically contain 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.

As of the end of May 2021, this is a new section/presentation, and I will be testing this recipe when the ingredients arrive early June. Stay tuned! :)

(2% dilution = 18 drops essential oil per 6 teaspoons carrier oil)

Essential oil: French lavender oil (Lavandula pedunculata)*
OR
Essential oil: [English] lavender (Lavandula angustifolia)**
Phytochemical: Camphor
Use: antifungal/antibiofilm
Amount: 6 drops

Essential oil: Peppermint oil (Mentha piperita)***
Phytochemical: Menthol
Use: antifungal/permeation enhancer
Amount: 6 drops

Essential oil: Thyme oil (Thymus vulgaris)****
Phytochemical: Thymol, p-cymene
Use: antifungal towards cell walls
Amount: 6 drops

Essential oil: [English] lavender (Lavandula angustifolia)
Phytochemical: 1,8-Cineol
Use: antifungal towards germ tube formation
Amount: included above

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 refrigerator


*French lavender (Lavandula pedunculata) contains 1,8-cineole and camphor and works against T. mentagrophytes, T. rubrum, E. floccosum, M. canis, and M. gypseum (Orchard & van Vuuren, 2017).

**[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 for essential oils. Avoid contact with everything except your toes. If you are pregnant, nursing, or under a doctor's care, consult your physician.

Cape Cod Foot Care, LLC 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 for toenails and bases of toes only. Creating your own essential oil mixes 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. 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.



References:

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

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
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Peppermint, lavender, and thyme

Mentha piperita, Lavandula augustifolia, Thymus vulgaris