Practice Perfect 963
Vicks for Nail Fungus: Sensible or Spurious?

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Much like most podiatrists, I spend a portion of my time treating patients with onychomycosis. And, like all podiatrists, I’ve listened to patients list what they have attempted to use to eliminate their nail fungus. One patient actually described that they urinated on their toenails in the shower to treat their onychomycosis! Yuck.

Perhaps the most common remedy – one even prescribed by some primary care physicians – is Vicks VapoRub^TM. For my entire career, I’ve scoffed at the idea that this solution could cure onychomycosis, a notoriously difficult condition to treat. Let’s take a slightly more scientific approach rather than just disregarding it outright and see if there’s medical evidence to support its efficacy as a treatment.

What Is Vicks VapoRub^TM?
Let’s first state what Vicks VapoRub^TM is. Table 1 shows the chemicals in this substance. I included active and inactive ingredients since any of these chemicals could potentially have an antifungal effect. For those who may not be aware, menthol is the ingredient responsible for the peppermint smell.

Are the Chemicals in Vicks VapoRub^TM Antifungal?
Readers will note a study for each of the active ingredients showing antifungal activity. However, there are a number of methodological issues that lower the strength of the evidence. In the first studies camphor and menthol were not examined against Trichophyton species, and these were not efficacy studies. In the eucalyptus study, the authors didn’t describe any methods to confirm the diagnosis of onychomycosis or what organism(s) were involved.

The other question about these that I can’t answer is how well these substances can penetrate the nail bed. All of these substances are hydrophobic, which, in theory, increases their ability to penetrate the skin. However, the nail unit is much thicker than regular skin, and has historically been very difficult to penetrate, which is the driving justification behind medications like efinaconazole and ciclopirox.

What Does the Clinical Literature Show?
Unfortunately, there are only two clinical studies examining the effectiveness of Vicks VapoRubTM for the treatment of onychomycosis. Snell et al⁴ prospectively studied 20 HIV+ males with clinically diagnosed onychomycosis for 48 weeks (no confirmatory testing). Five patients were lost to follow up at 48 weeks (20% loss). At 24 weeks, they reported 83% had improved appearance with median clearance of 25%. They reported that this treatment was “effective and safe,” but looking at the methodology, I have to disagree. Safe is ok to say, but this study is so full of holes it really shouldn’t be used to make any decisions. There was no control group or treatment, the study size was too small (if they had done an intention to treat analysis, those 5 patients would have destroyed the reported positive results), they never properly confirmed if the patients had onychomycosis (they changed culture techniques midway through the study which should have led to restarting the study) and there’s no actual statistical analysis beside the descriptive percentages. This is all besides the lack of generalizability from the study due to the HIV+ immunocompromised patients (much harder to treat than the average patient).

A study by Derby and colleagues in 2011⁵ had a much better methodology. They studied the effect of Vicks VapoRub^TM on 18 participants with mycologic and clinical cures as primary outcomes. This is much better since it more closely matches studies on prescription medications. Five of 18 patients (27.8%) had mycologic and clinical cures at 48 weeks. Ten (55.6%) had partial clearance. Three (16.7%) showed no change. All 18 were satisfied or very satisfied on a survey at the end of treatment. The mycologic cure percentage is very low, but patients were satisfied with an improved appearance. Because this was a pilot study (hence the low patient number), we must be cautious not to lend too much significance to the outcome.

A recent narrative study by Valido, et al in February of this year (2025)⁶ found the evidence to be “limited and inconclusive.” I think that’s a generous description of where the current state of knowledge is in regard to Vicks VapoRub^TM. Based on the evidence that the ingredients don’t appear to actually target common dermatophytes and the sparse and methodologically weak studies I will not be recommending this medication to my patients. Given the safety, higher quality research, and higher rates of mycologic cure, I will continue to recommend oral terbinafine to most of my patients with onychomycosis.

Best wishes.

Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]