Fungal infection of the nail is a common condition that causes much concern because of its disfiguring appearance. Although specific treatment is available for this condition, treatment outcome is variable and persistent nail dystrophy post-treatment may cause distress to both the patient and the physician. This article describes the current available treatment options for onychomycosis, management approach and the expected treatment outcome to enhance primary care physicians' confidence in managing this condition. Oral antifungal agents such as terbinafine and itraconazole are good treatment options for onychomycosis. Combination therapy using oral antifungal agents with topical lacquer preparations may provide added benefits. Evaluation of patient's expectations, providing information on treatment outcome, clinical cure and recurrence rates are essential in the management of onychomycosis. This article is intended to guide primary care physicians to achieve realistic treatment goals and for a satisfactory experience in the overall management of this challenging condition.