Onychomycosis Treatment Options
A guide to the 3 FDA-cleared topical medications and the Remy Class IV Laser treatment for treating nail fungus (Tinea Unguium) — and how combining laser with topicals offers the most comprehensive approach.
Presented by Dr. David Velarde, DPM
Meet Dr. David Velarde, DPM
Dr. Velarde specializes in the diagnosis and treatment of onychomycosis (nail fungus). His approach combines the latest FDA-cleared topical medications with advanced Class IV laser therapy to deliver the most effective, patient-friendly outcomes.
This guide covers every treatment option available — from prescription topicals to in-office laser — including insurance coverage, cash pricing, and compliance considerations to help you make an informed decision.
Your Treatment Options at a Glance
Five approaches to treating nail fungus, ranging from topical prescriptions to advanced laser therapy.
01
Ciclopirox 8% Lacquer
FDA-approved topical lacquer — limited by poor penetration and compliance issues.
02
Tavaborole 5% Solution
Dr. Velarde's preferred topical — superior penetration, easy daily use, ~$50 cash price.
03
Efinaconazole 10% (Jublia)
Third FDA-cleared topical option — typically more expensive with limited insurance coverage.
04
OTC & Natural Products
Tea tree oil, undecylenic acid, urea — results vary; consistency is key.
05
Remy Class IV Laser
30-watt, dual-wavelength, FDA 510K-cleared laser — most comprehensive when combined with topicals.

Option 1: Ciclopirox 8% Lacquer
FDA-approved to manage and control some nail fungus for some individuals — but with significant practical limitations. Dr. David Velarde no longer prescribes it routinely.
Poor Nail Penetration
Studies show ciclopirox is not effective at penetrating the nail compared to Tavaborole.
Tacky Lacquer Formula
Sticks to socks. Dye from colored socks can stain nails black or the color of the sock.
Maintenance Required
Must be removed weekly with alcohol or acetone. Most patients are not compliant due to these nuisances.
Ciclopirox can cause permanent-looking staining from sock dye.
Option 2: Tavaborole 5% Solution
Dr. Velarde's Preferred Choice
Tavaborole offers superior performance and patient compliance compared to ciclopirox, making it Dr. Velarde's go-to topical recommendation for onychomycosis.
Superior Penetration
Clinically shown to penetrate the nail more effectively than ciclopirox.
Easy Daily Use
Once-daily application — no lacquer, no sticky residue, no staining.
Better Compliance
Patients are far more likely to complete treatment due to its ease of use.
Affordable Cash Price
~$50 for a 10mL bottle at Signal Mountain Pharmacy or CVS on Ridgeway Ave.
Options 3 & 4: More Topical Choices
Option 3: Efinaconazole 10% (Jublia)
The third FDA-cleared topical option for nail fungus. Another viable choice if needed, though typically more expensive with limited insurance coverage.
If pursuing insurance approval for Tavaborole, contact your insurer directly. Ask your pharmacy for the cash price before proceeding with any paperwork.
Option 4: OTC & Natural Products
Many over-the-counter or doctor-dispensed topicals contain tea tree oil, undecylenic acid, urea, or other antifungal agents. Results vary by individual.
Consistency is key. These can be used alone or alongside other therapies for a layered approach.
Option 5: Remy Class IV Laser Treatment
The Remy is a 30-watt, dual-wavelength, FDA 510K-cleared Class IV laser used in Dr. Velarde's office. When combined with a topical antifungal, it offers the most comprehensive approach to eliminating nail fungus.
How It Works
Targeted wavelengths penetrate the nail plate. Fungal pigment absorbs the energy as heat, selectively destroying the fungus while leaving healthy tissue unharmed.
Treatment Protocol
Performed in-office in a series of sessions. No anesthesia required — quick, comfortable, and non-invasive with no downtime.
FDA-Cleared & Safe
510K FDA-cleared for fungal toenails. Safe for most patients, including those who cannot tolerate oral antifungal medications.
Why Combine Laser + Topical?
Laser alone destroys active fungus — but pairing it with Tavaborole 5% Solution or another topical antifungal helps prevent recurrence and supports healthy nail regrowth for the best long-term outcome.

Laser treatment is a cash-pay service not covered by insurance. Ask our office for current pricing and available treatment packages.
Cash Price Comparison: Tavaborole
Where you fill your prescription makes a significant difference. Dr. Velarde recommends these local options for the best value on Tavaborole 5% Solution.
~$50
Preferred Price
Signal Mountain Pharmacy or CVS on Ridgeway Ave, Signal Mountain — 10mL bottle of Tavaborole.
$189–$400
Most Pharmacies
Typical cash price range for Tavaborole 5% Solution at most other pharmacies nationwide.

Knowing where to fill your prescription can save you up to $350 on the same medication. Always ask for the cash price before submitting insurance.
Ready to Treat Your Nail Fungus?
Dr. David Velarde, DPM offers a full spectrum of onychomycosis treatments — from Tavaborole 5% Solution (his preferred topical at ~$50) to the Remy Class IV Laser for the most comprehensive results. The right combination depends on your individual case.
Topical Only
Tavaborole 5% Solution — affordable, easy daily use, superior nail penetration.
Laser + Topical
Most comprehensive approach — destroys active fungus and prevents recurrence.
Ask About OTC
Natural and OTC options available to complement any treatment plan.