Novel Treatment of Onychomycosis Using Over-the-counter Mentholated Ointment: A Clinical Case Series

Richard Derby, MD; Patrick Rohal, MD; Constance Jackson, MD; Anthony Beutler, MD; Cara Olsen, PhD, MPH


J Am Board Fam Med. 2011;24(1):69-74. 

In This Article

Abstract and Introduction


Background: Current medication treatments for onychomycosis have less than full cure-rate efficacy and have the potential for adverse side effects. Vicks VapoRub (The Proctor & Gamble Company, Cincinnati, OH) has been advocated in the lay literature as an effective treatment for onychomycosis. This pilot study tested Vicks VapoRub as a safe, cost-effective alternative for treating toenail onychomycosis.
Methods: Eighteen participants were recruited to use Vicks VapoRub as treatment for onychomycosis. Participants were followed at intervals of 4, 8, 12, 24, 36, and 48 weeks; digital photographs were obtained during initial and follow-up visits. Primary outcome measures were mycological cure at 48 weeks and clinical cure through subjective assessment of appearance and quantifiable change in the area of affected nail by digital photography analysis. Patient satisfaction was a secondary outcome, measured using a single-item questionnaire scored by a 5-point Likert scale.
Results: Fifteen of the 18 participants (83%) showed a positive treatment effect; 5 (27.8%) had a mycological and clinical cure at 48 weeks; 10 (55.6%) had partial clearance, and 3 (16.7%) showed no change. All 18 participants rated their satisfaction with the nail appearance at the end of the study as "satisfied" (n = 9) or "very satisfied" (n = 9).
Conclusions: Vicks VapoRub seems to have a positive clinical effect in the treatment onychomycosis.


Toenail onychomycosis is a common diagnosis for primary care physicians. The prevalence of onychomycosis in the North American adult population may range from 2% to 18%, with prevalence increasing to 20% and 30% for those older than 60 years and 70 years, respectively.[1–5] Onychomycosis is commonly associated with tinea pedis. Significant physical and psychological effects, such as pain and negative self-image, may occur in patients with onychomycosis.[6]

Dermatophytes Trichophyton rubrum and Trichophytonmentagrophytes are the predominant pathogens in onychomycosis; nondermatophytes (usually Candida) account for a smaller percentage (10% to 20%) of toenail onychomycosis.[1,7] Presentation of infection may occur in various patterns: fungal invasion of distal or lateral margins of the nail (distolateral subungual onychomycosis); direct effect from above or on top of the nail with a powdery, white, patchy discoloration (superficial white onychomycosis); or infection beginning from the proximal location beneath the nail bed (proximal subungual onychomycosis).[7]

Current treatment agents for onychomycosis include both systemic and topical medications. A meta-analysis of systemic therapies showed mycological cure rates of 76% with the use of terbinfine, 63% with the use of itraconazole pulse dosing, 61% with the use of griseofulvin, and 48% with the use of fluconazole.[8] Downsides to oral therapy include the potential for adverse side effects, most notably hepatotoxicity, and the significant cost of the medication course, which is typically of 3 months' duration. Ciclopirox 8% is a topical lacquer solution that has been approved by the US Food and Drug Administration for treatment of onychomycosis, with reported mycological cure rates of 34% in meta-analysis studies of North America patients.[9] Cure rates of ciclopirox 8% and other topical therapies that have not been approved by the US Food and Drug Administration (eg, amorolfine 5% and tioconazole 28%) are lower than those observed with systemic treatments, and the course of topical treatments ranges from 6 to 12 months.[7]

Vicks VapoRub (The Proctor & Gamble Company, Cincinnati, OH) has been popularized by lay medical Web sites as a home cure for onychomycosis.[10] No published trials examining the effect of this compound on onychomycosis have been accomplished. However, the active and inactive ingredients in Vicks VapoRub (thymol, menthol, camphor, and oil of Eucalypus) have shown efficacy against dermatophytes in vitro.[11–14] The purpose of this pilot study was to test the efficacy of Vicks VapoRub as a safe, cost-effective alternative for treating toenail onychomycosis in an outpatient clinic setting.