Fungal nail infection treatment: what works and how long it takes

The short answer

If a fungal nail infection is not bothering you, you do not have to treat it. It will not clear by itself, though, according to the British Association of Dermatologists (BAD), so if you want it gone you need a medicine.

The treatment with the strongest evidence is terbinafine tablets, prescribed by a GP and usually taken for 6 weeks to 3 months. Nail lacquers you can buy from a pharmacy are easier to use, but on toenails they work far less often. Laser and home remedies have little good evidence behind them.

Whatever you choose, the nail itself is slow. A toenail grows about 1.6 mm a month, so a successful treatment still takes 12 to 18 months to show as a clear nail, and reinfection is common. Keeping the nail short and thin makes it more comfortable and helps treatment reach the fungus. That is the part a foot health professional can help with, alongside, not instead of, the medicine.

Signs of a fungal nail infection

The NHS describes a nail that is brittle, discoloured or thicker than usual. It usually affects toenails and usually starts at the edge of the nail. It can spread to the whole nail, turning it white or yellow. The nail may become crumbly, and sometimes it lifts off, with the skin around it swollen and painful. The NHS also says these infections are not serious, but can take a long time to treat.

Not every thick or yellow nail is fungal. The BAD notes that other nail problems, such as psoriasis, can look very similar. That is why a GP may take a clipping of the nail and send it to a laboratory before prescribing tablets; the BAD says results can take several weeks. The NHS nail problems page notes that nails can become thicker with age, and injury or pressure from shoes can thicken them too, which we cover in our guide to thick toenails.

How common is it?

Common, but the figures vary a lot with how they are counted. The BAD leaflet says about 1 in 4 people can be affected at a given time. Studies that look at the general population find lower numbers:

• A 2014 review of prevalence studies found an average of 4.3% in population studies in Europe and North America, and 8.9% in studies of hospital patients.
• A UK survey of 9,332 adults, carried out in 1990 with photographs of nail changes, found about 2.7%. It rose with age, from 1.3% at 16 to 34 to 4.7% at 55 and over.

The UK survey is old and relied on people recognising their own nails, without laboratory tests, so it is a rough guide rather than a precise count. The BAD leaflet and the UK survey agree that it becomes more common with age.

Most fungal nail infections are caused by a group of fungi called dermatophytes, says the BAD, which lists the people who get them most often: older people, people with diabetes, people with poor circulation in the hands or feet, and people with a weakened immune system. The NHS adds that feet which are often warm and damp, for example from wearing trainers for long periods, make an infection more likely, and that athlete's foot can spread to the nails if it is not treated.

Terbinafine tablets: the strongest evidence

The BAD calls terbinafine "the usual first choice" for nail infections caused by dermatophytes. A Cochrane review from 2017 pooled 48 trials with 10,200 people. It found high-quality evidence that terbinafine beats a dummy tablet for both a normal-looking nail and clearing the fungus, and moderate-quality evidence that it probably works better than azole tablets such as itraconazole, with a similar risk of side effects.

The review reports its results as relative risks. To see what that means for a person, here are the individual trials:

Two things are worth knowing. First, "clear of fungus" in a laboratory test is not the same as a nail that looks normal, and the gap between the two is large. Second, results were lower in older people, which matters because they are the people most likely to have the infection.

The NHS lists common side effects (in more than 1 in 100 people) including headache, rash, stomach upset and losing your sense of taste. Liver problems are rare, in fewer than 1 in 1,000 people, and the NHS fungal nail page says a GP may arrange blood tests to check your liver. Tablets are not suitable for everyone, including some people with liver or kidney disease, and may not suit you if you are pregnant or breastfeeding.

Amorolfine nail lacquer: easy to buy, weak on toenails

Amorolfine 5% lacquer is the most common treatment you can buy over the counter, says the BAD. The NHS says pharmacy nail medicines are brushed on daily or weekly, depending on the type, and need to be used for 6 to 12 months. The BAD adds that lacquers work best for early infections and are less effective than tablets.

Two trials on toenails show how big that difference can be:

• In a Finnish trial of 73 people (2015), 9 months of weekly amorolfine cleared the fungus in 8% at 10 months. Three months of terbinafine tablets cleared it in 56%.
• In a Dutch trial in general practice (2024), 111 people used amorolfine, miconazole or a dummy treatment for 6 months. Nobody using amorolfine had a complete cure, and it did no better than the dummy. The authors concluded these treatments should not be advised on their own.

Both trials were small, and 6 months is a short time for a toenail, so they do not prove a lacquer never helps. A 2020 Cochrane review of 56 trials found that some topical treatments, such as efinaconazole and ciclopirox lacquer, did beat a dummy treatment, but it described complete cure rates with topical treatments as relatively low. A lacquer is most worth discussing with a pharmacist for an early infection, or if tablets do not suit you.

Laser treatment: the evidence is weak

The same 2020 Cochrane review looked at laser. It found three trials of Nd:YAG laser with 112 people in total. At 52 weeks, laser made no clear difference to clearing the fungus compared with no treatment or a sham treatment. The evidence was rated low certainty, the trials did not measure complete cure, and the review could not say how safe it was. The review also noted that device treatments were under-represented in the research, so their effect is uncertain.

The BAD says laser and light treatments "have not shown consistent and reliable benefits", and for that reason they are not funded by the NHS. If you are thinking of paying for laser, it is fair to ask what result is being promised and which published trial it comes from.

Home remedies: what the evidence says

Home remedies are popular because they are cheap and easy to try. The research behind them is thin:

• Tea tree oil. A 1994 trial of 117 people compared 100% tea tree oil with clotrimazole solution, both twice a day for 6 months. The fungus cleared in 18% with tea tree oil and 11% with clotrimazole, and about 60% in each group saw some or full improvement in how the nail looked. There was no dummy group, so we cannot tell how much of that either product caused.
• Vapour rub. A 2011 study asked 18 people to apply Vicks VapoRub. At 48 weeks, 5 were clear. With no comparison group and so few people, it cannot show whether the rub did anything.
• Vinegar, bleach, hydrogen peroxide or garlic. We searched Europe PMC and found no clinical trials of these for fungal toenails.

If you want to try something at home, ask a pharmacist first, particularly if you have diabetes, because the NHS notes that foot problems can be more serious then.

How long treatment takes

No treatment repairs the damaged part of the nail. The medicine stops the fungus, and then healthy nail has to grow out from the base and push the damaged part off the end. The NHS puts it simply: the infection is cured when you see healthy nail growing back at the base.

That takes time because toenails are slow. A study of 22 healthy young adults found toenails grew 1.62 mm a month, less than half the speed of fingernails at 3.47 mm. The big toenail grew faster than the other toenails. The people in that study were young, so many readers' nails will be slower still. The BAD says toenail infections may take 12 to 18 months to clear, and fingernails 9 to 12 months.

Where nail reduction fits

An infected toenail often becomes thick and crumbly, which makes it hard to cut and uncomfortable in shoes. The BAD leaflet says "clipping away (debulking) infected parts of the nail helps treatments work better", and that thinning, trimming or filing nails removes infected material and makes nails more comfortable.

There is some trial support for doing both together. In the IRON-CLAD trial of 504 people, adding thorough nail reduction (debridement) to terbinafine tablets raised the clinical cure rate from 51.4% to 59.8%. People knew which group they were in, which can colour results.

On its own, though, nail reduction does not clear the fungus. In a 2009 trial, none of the 27 people who had nail reduction alone ended up clear of fungus, while the group who also used an antifungal lacquer did better. So think of it as support: a thinner, shorter nail is more comfortable, is easier to keep clean and short as the NHS advises, and gives the medicine a better chance.

Stopping it coming back

The BAD warns that even after successful treatment it is common for nails to become reinfected; in the five-year follow-up above, the fungus came back in 23% of people after terbinafine. These steps, from the NHS and the BAD, lower the odds:

• Treat athlete's foot promptly, so it does not spread to the nails.
• Keep nails short, clean and dry, and use separate clippers for an infected nail. Do not share clippers, scissors or towels.
• Wear clean socks every day and shoes that let your feet breathe. Try not to wear the same shoes two days running, and throw out old shoes.
• Wear flip-flops or shower shoes in gym, pool and other shared showers, and do not wear other people's shoes.
• Choose well-fitting shoes without high heels or narrow toes.

For how to keep nails short without causing an ingrown toenail, see how to cut toenails properly.

When to see a pharmacist or GP

The NHS suggests seeing a pharmacist if the look of the nail bothers you or it is painful. They can suggest a nail medicine and tell you whether it suits you.

See a GP if:

• the infection is severe and pharmacy treatment has not worked
• it has spread to other nails
• you have diabetes
• you have a weakened immune system, for example after an organ transplant or during chemotherapy
• the skin around the nail has become sore, red, swollen and warm, which the NHS nail problems page lists as a reason to see a GP

A GP can confirm the diagnosis with a nail sample, prescribe tablets and, for a badly infected nail, arrange removal under local anaesthetic. If you have diabetes, read our guide to diabetic foot care too, because foot problems can be more serious.

How we checked

On 10 November 2026 we read the NHS pages on fungal nail infection, nail problems and terbinafine, and the British Association of Dermatologists' patient leaflet on fungal nail infections. For treatment results we went to the research itself: two Cochrane reviews (oral treatments, 2017; topical and device treatments, 2020) and the individual trials listed below, read through their published abstracts on Europe PMC. NICE Clinical Knowledge Summaries refused automated reading, so we relied on the Cochrane reviews and trials instead. Where only an abstract was available, we used only the figures it reports.

We left out figures we could not trace to a first source, and we did not use clinic, product or forum pages. This guide is general information, not a diagnosis. If you are worried about a nail, see a pharmacist, a GP or an NHS podiatrist.

Where Fairy Feet fits

Marianna Tapai FHP is a qualified Level 4 Foot Health Practitioner who has worked with nails and feet since 2006, from her own studio in Doncaster. Her Fungal Nail Advice and Treatment (£29.99) covers the nail care side described above: trimming and thinning a thickened nail so it is more comfortable and easier to keep short, and talking through the everyday steps that lower the chance of reinfection. If you also need the rest of the foot looked after, there is the Foot Health Treatment / Medical Pedicure.

Marianna is a Foot Health Practitioner, not a podiatrist. She does not diagnose fungal infection, prescribe medicines or remove nails. For a nail test or tablets, see your GP; for a lacquer, ask a pharmacist. See a GP before booking anything if you have diabetes and the nail is changing, if you have a weakened immune system, or if the skin around the nail is red, hot or swollen. Marianna can work alongside whatever your GP or pharmacist suggests.

To ask a question or arrange a visit, use the form on the contact page; there is no online booking.

Questions people ask

Sources

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