Problems with thick, ugly toenails? It is probably fungal nail – clinically known as onychomycosis. Traditionally, this problem has been treated with costly oral antifungal medications that require frequent laboratory monitoring due to potential liver toxicity, because it is difficult to penetrate the thick nail with topical antifungals. Good news! Studies have shown that when urea which softens the nail or penetrant enhancers are added, topical antifungal nail preparations have produced excellent results. Topical preparations typically produce higher drug levels at the application site but lower levels in the blood, and therefore fewer side effects compared to oral medications. A randomized, double-blind study showed that topical treatment of fungal nail using a combination of the antifungal medication fluconazole 1% and urea 40% was more effective (82.8%) than fluconazole alone (62.8%). Fluconazole was well tolerated and side effects were negligible.