If you have a fungal finger- or toenail infection (onychomycosis), it might seem logical that you should just drop in at the nearest pharmacy and buy a tube of over the counter (OTC) nail fungus cream. After all, that approach usually works for other uncomplicated and superficial skin infections: an OTC antibiotic ointment or antiseptic liquid usually does the trick. With a fungal nail infection, however, it's often not that simple.

Nail fungus cream is certainly available, and people have been buying it for years, but though it works quite well on fungal skin infections, it doesn't have a great reputation for clearing up onychomycosis. Antifungal cream often doesn't work for a very simple reason: when you smear it on your nail, you are not putting it directly on the fungus. The fungus is growing in the nailbed, protected from the treatment by a thick layer of fingernail or toenail. The medication is outside and the infection is inside.

In some circumstances, though, OTC nail fungus cream may clear up the problem, or at least help to do so. If you work at getting the cream to the site of the fungal growth, it may help. Do this by soaking the infected hand or foot to soften the thick nail. Then, use a file or emery board to gently file away some of the thickness and remove any loose disintegrating areas. This will not only physically remove some of the fungal growth, it will also remove some of the material that would otherwise separate the antifungal cream from the infected area. Apply the treatment to the softened, filed nail liberally and often. (Follow manufacturer's directions and be sure not to miss any applications.)

Another way to boost the effectiveness of antifungal cream is to combine it with another remedy. There are oral prescription drugs that you can take, which attack the infection from within, rather than topically. See you doctor to find out whether one of these drugs would be appropriate for you. There are also natural remedies that use something taken by mouth or a combination of oral and topical agents. Though it may require a bit more work, a combination of nail fungus cream and something else may be the best approach to a hard-to-treat infection.