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 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:
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 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:
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
Is Vick's VapoRub a Good Option?
The petrolatum in Vick's VapoRub will soften fungal debris.
If your nail is less than 25% affected by fungus along the end of the nail (free edge) and under the nail plate, then Vick's VapoRub will assist in removing the fungal debris and possibly slow/stop additional debris from forming. Vick's VapoRub may be beneficial for your nail. If you don't like the smell, consider an oil based mixture, which will also hydrate the nail bed and assist in nail plate reattachment.
If your nail is more than 25% affect by fungus, or the affected area is only along the side or the back of the nail, or the nail plate is affected, then Vick's VapoRub will soften the fungal debris, but the debris will not be easily removed, and your nail may become waterlogged and soft. An alternative option is to use an oil based mixture as described below.
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 toenails, including the base of the nail, once a day. In addition to application once a day, please consider additional steps to inhibit fungal growth.
Never do anything that causes pain. If anything hurts or looks infected, stop using these products and see a foot care professional.
Loose fungal debris will need to be removed before applying Vick's VapoRub or the essential oil mix. Using Vick's, olive oil, or essential oil mixes will help soften the debris and may help slow or stop additional debris from forming, but the debris still needs to be cleared away. Without removal of the debris: 1) more debris will form and 2) the nail plate cannot reattach to the nail bed. If you are unable to safely remove the debris on your own, find a professional or loved one with a gentle touch who can help remove the debris from under the nail with a small, blunt file. Do not separate the nail plate from the nail bed.
Mentha piperita, Lavandula augustifolia, Thymus vulgaris
Creating Your Own Antifungal Essential Oil Mix
For "clear, healthy looking nails" (because it has not undergone FDA testing).
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, 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 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.
Vick's VapoRub and Antifungal Essential Oil Mix - Do They Really Work?
Below are feet that I have access to daily. With any treatment option, consistency is key.
What's going on with these feet? This is called Pitted Keratolysis and it's a bacterial infection of the first layer of skin. It's not itchy and it gets worse with wet feet. People who wear work boots all day long in the elements with sweaty feet are prone to getting it. The following recommendations apply to fungus as well.
Below is a comparison of the Vick's VapoRub and the essential oil mix to see which worked best, or worked at all. I see an improvement. For best results on nails, it depends how fast your nail grows and where the fungus is located. If you have a small amount on the front the the nail, it may take less that 2 months. If the fungus is at the base of the nail, it can take up to 18 months
Essential Oil Mix Left Foot
June 14, 2021 - Day 0
June 27, 2021 - 2 weeks
July 27, 2021 - 6 weeks
Vick's VapoRub Right Foot
June 14, 2021 - Day 0
June 27, 2021 - 2 weeks
July 27, 2021 - 6 weeks
Vick's VapoRub and Antifungal Essential Oil Mix - A Fungal Nail Case Study - COMING SOON!
Comparison testing on fungal nails is in progress, results coming soon!
If you would like to try out applying Vick's VapoRub and/or the aforementioned antifungal essential oil mix, please contact me with any questions.
Day 0 and monthly photos are encouraged.
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