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Urea and mild salicylic acid are both keratolytic and can break down the nail plate to make it more penetrable.  The hallmark in to trying to treat your nails topically is to thin the nails out with a nail file once a week while applying the medications once or twice a day.

The third option is to treat them orally.  There are currently two medications to treat fungus toenails.  These include Sporanox and Lamisil.  Both these medications have to be taken for 90 days.  Lamisil is taken once a day and Sporanox is pulsed dosed so one takes 4 pills a day for 7 days and then does not take any medications for 21 days.  This is repeated 2 more times.  The success rate of oral medications is approximately 65% per medical documentation.  Laboratory studies should be performed to evaluate liver enzymes prior to treatment and again at 6 weeks.  Complications from the oral medication include but are not limited to elevation of liver enzymes, taste disturbances in the last week of treatment and possible allergic reactions.  

The fourth option is to treat them by removal of the toenails and letting them grow back.  Concurrent treatment with topical medications on the empty nailbed is recommended.  60-70% of the nails grow back to look similar to the nail that was removed.

The fifth option is to have the toenails removed so they do not grow back.  Nails are removed and either sodium hydroxide or phenol is used to cauterize the growth center.  Success rates are about 90% for no nail regrowth.  Cosmesis is a problem because no toenail exists on the nail beds.  This treatment is utilized for toenails that are exquisitely painful, curved in and thickened and no other treatment options are available.

The sixth option is to treat the toenails with a laser.  Published data results suggest this is a reasonable option for people who don't want the side effects of oral medication and where topical medication did not work.  The laser beam travels through the nail plate to the nailbed which is where the fungus is.  The laser light is absorbed by the pigment in the fungi, which causes the pigment to heat.  This heat kills the fungal organism.  This can result in your nail growing normally.  This modality is 75% effective.  

Some of the basic principles for treatment of mycotic toenails need to be expressed:

Those who treat the fungus when it first develops are more likely to have a successful outcome.  Those who treat the fungus when it involves only one toenail have also a more successful outcome.  Obtaining a fungus culture of a toenail clipping and/or biopsy of the nail plate should be done prior to oral and/or laser treatment.  In many cases treatment of thick toenails which have no fungus in them but are just traumatized decrease the success rate of the oral medications and/or laser treatment.  Once you have established treatment,  cleaning and desanitizing of showers, bathrooms and current shoes is essential to prevent
reinfestation. Onychomycosis is ubiquitous which means it is everywhere and we have to fight very hard to keep fungus from getting back in our toenails Those that have very thick fungus toenails where the fungus has actually caused a dystrophy(or trauma and thickening) to the nail plate can have the fungus eradicated and the nail color cleared but the nail may remain more thickened than a normal nail would.