Treatment of Fungal Toenail: Benefits, Risks and Options

A fungal toenail infection makes the nail thick, yellow or white and crumbly, and it rarely clears on its own. The treatment of fungal toenail infection works best when a lab test confirms the fungus first, because several other conditions look the same. This guide explains the treatment of fungal toenail problems, from nail lacquers and tablets to lasers and nail removal, and how to stop the fungus coming back.

Key takeaways

• A nail clipping test confirms the fungus before months of treatment.
• Tablets work better than lacquers, but even a cured nail takes a year or more to grow out.
• Laser treatment is less proven and is not covered by Medicare.
• A Medio doctor can assess your nail by phone, look at photos and arrange the test.

Nail Removal for Severe Infections

Nail removal is kept for a nail that is very thick, painful or not responding to other treatment. It is one option in the treatment of fungal toenail infection, usually combined with an antifungal, because removing the nail alone does not clear the fungus from the nail bed.

Removal can be partial or total, using a minor procedure under local anaesthetic or a strong urea paste that softens the nail over a few weeks. The new nail grows back over 12 to 18 months, and the infection can return in it, so treatment and foot care continue while it grows. A podiatrist can also thin a thick nail regularly, which eases pain and helps a lacquer reach the fungus.

For most fungal nail infections, lacquers or tablets come first, and removal is kept for nail infections that have not responded or a nail fungus that causes pain.

Diagnosis With a Nail Clipping Test

A diagnosis of a fungal nail infection is confirmed by sending nail clippings and scrapings from under the nail to a laboratory, which looks for fungus under a microscope and tries to grow it. Results take two to six weeks. The test matters because only about half of thick, discoloured nails are fungal; others come from psoriasis, repeated injury from shoes, or nail changes with age, and these do not respond to antifungal treatment.

Confirming the fungus before starting tablets is standard practice in the treatment of fungal toenail infection, as the course lasts months. The medical name for the condition is onychomycosis, and the test also shows which fungus is involved, which can change the choice of treatment. A Medio doctor can send a pathology request for the test, and a collection centre, podiatrist or GP clinic can take the clippings. Avoid applying a nail lacquer for a few weeks before the test, as it can stop the fungus growing in the lab and give a false negative result. If nail fungus is confirmed, the doctor can plan treatment and nail care with you.

What Causes a Fungal Toenail Infection

A fungal toenail infection is usually caused by the same fungus that causes athlete's foot, which spreads from the skin between the toes into the nail. Fungus grows best in warm, damp, dark places, so sweaty feet, tight shoes and walking barefoot in communal showers, pools and gyms all raise the risk. A nail that has been injured, for example by a tight shoe or a dropped weight, lets the fungus get under the nail more easily, and once there the fungus feeds on the nail bed and the nail itself. Fungal nail infections become more common with age, as nails grow more slowly, and are more likely with diabetes, poor circulation, smoking, psoriasis, or an immune system weakened by illness or medicines. They often run in families.

The infection spreads slowly from one nail to others and can pass to other people through shared floors, towels and nail clippers. Knowing these causes helps the treatment of fungal toenail infection succeed, because the same conditions let a fungal nail infection return after treatment. Less often, yeasts or moulds are the cause, and these may need a different medicine.

Lacquers and Tablets in the Treatment of Fungal Toenail

Lacquers and tablets are the two main ways to treat a fungal nail. A medicated nail lacquer, sold at pharmacies, is painted on once or twice a week after filing the nail surface, and suits a mild fungal nail near the tip of one or two nails. It needs six to twelve months of use and clears the fungus less often than tablets, but it has few side effects.

For moderate or widespread nail fungus, tablets work better. The usual tablet is terbinafine, which is only available on prescription in Australia, taken daily for about three months for toenails. It stays in the nail and keeps working after the course ends, so the nail looks better slowly over the next year as healthy nail grows out. Side effects include an upset stomach, rash and a change in taste, and rarely liver problems, so the doctor may arrange a blood test and checks your other medicines. People with diabetes, heart failure or liver disease need a careful choice.

Treatment is worthwhile when the nail is painful, spreading or a risk to the foot, while a nail that bothers you only for cosmetic reasons can be weighed against the cost and side effects. The nail fungus is cured when new nail grows in clear, which can take 12 to 18 months for a big toe.

How Well Laser Treatment Works

Laser treatment for nail fungus has less evidence than tablets. The heat from the laser aims to damage the fungus without harming the toe, and studies show it can improve how an infected nail looks, but fewer people are cured than with tablets, and many need several visits. Hot lasers can feel warm or like a pinprick; cold lasers are painless but have even less evidence. Laser is usually offered by a podiatrist, is paid for privately and can add up across a course, with no Medicare rebate. It may suit people who cannot take medication by mouth, such as those on many other medicines or with liver disease, and it works better alongside a lacquer than on its own.

Before booking, ask the podiatrist whether your nail has been tested, how many visits are planned and what results they see. Remove any nail polish before each visit. A fungal nail can still return after laser, so foot care matters as much after treatment as before. Laser does nothing for the fungus in the skin of the foot, which is often infected too, and treating that at the same time lowers the chance of the fungal nail coming back. People whose immune system is weak should see a doctor before choosing laser over proven treatment, as infected nails can lead to skin infections. Yellow or brown discolouration may take months to fade even after the fungus has gone.

Prevention of a Returning Fungal Toenail

Prevention matters because a fungal nail returns in many people within a few years, even after successful treatment. Treat athlete's foot early with a cream from the pharmacy, as it is often where the fungus comes from. Dry your feet well, especially between the toes, change your socks every day, and choose breathable shoes, letting each pair dry out for a day between wears. Wear thongs in communal showers, pool areas and gym change rooms.

Keep nails short and cut straight across, use your own clippers and clean them after use, and do not share towels or footwear. An antifungal powder in shoes helps some people. Some doctors suggest using a nail lacquer once a week for a while after treatment to lower the chance of nail fungus coming back. If a nail starts to thicken or change colour again, see a doctor early, when a small area of nail infection is easier to treat. Nail salons should clean tools between clients; ask, or take your own. Those who have had fungal nail infections before, or who have diabetes, benefit most from checking their feet each week.

When a Fungal Toenail Needs a Doctor

See a doctor about a fungal nail if over the counter treatment has not helped after a few months, if several nails are affected, or if you are not sure it is fungus at all. See a doctor promptly if you have diabetes, poor circulation or a weak immune system, because a nail infection in those feet can lead to skin breakdown and bacterial infection; a podiatrist should also check your feet regularly.

Redness, warmth, swelling, pus or pain around the nail suggest a bacterial infection, which needs care within a day, and spreading redness with fever needs urgent care: call 000 if you feel very unwell. A dark brown or black streak in the nail, a change in the skin around it, or a nail that bleeds or lifts without a clear cause needs an in person check, because a rare skin cancer can look like nail fungus. Symptoms that point to fungus are a thick, yellow, white or brown nail that crumbles at the edge and lifts from the nail bed. A topical treatment is reasonable for mild changes, but tablets need a doctor. Fungal nail infections in children should be seen by a GP in person.

How Reliable Home Remedies Are

Home remedies for nail fungus have little good evidence. Tea tree oil has shown small effects in a few studies but often irritates the skin, and vinegar soaks, menthol rubs, garlic and baking soda have not been shown to cure a fungal nail. Bleach and other household chemicals can burn the skin and should never be used. Covering an infected nail with nail polish hides it but traps moisture, so leave polish off while treating.

The reason most remedies fail is that the fungus lives under and inside the nail, where little reaches it, which is why even prescription topical lacquers work slowly. A podiatrist can file and thin the nail so treatment reaches deeper, and a podiatrist or doctor can tell you whether the problem is fungal at all. Simple habits do help: dry feet, fresh socks, and treating any fungal infection of the skin, such as itchy, peeling skin between the toes, early. Fungal nail infections are common, but they do not go away with time, and a podiatrist or doctor can suggest a proven treatment. Nail infections caused by yeasts, more common in fingernails, also need proper treatment rather than home remedies.

Summary

The treatment of fungal toenail infection is slow but usually works when the fungus is confirmed and the right option is chosen. This guide covered nail removal, the clipping test, causes, lacquers and tablets, laser, prevention, when to see a doctor and home remedies. If you want help with the treatment of fungal toenail problems, a Medio doctor can assess your nail by phone, look at photos and, where the doctor thinks it right, send a pathology request, an eScript or a referral.

Frequently asked questions

How can fungal nails be removed?

Fungal nails can be removed partly or fully by a podiatrist or doctor, either in a minor procedure under local anaesthetic or with a strong urea paste that softens the nail over a few weeks. Removal is kept for very thick or painful nails and is combined with an antifungal, because the fungus also lives in the nail bed. Do not try to pull a nail off at home. Left untreated, fungal nails can cause other problems, such as pain when walking and skin infections, and toenail fungus can cause permanent damage to the nail, which may stay thick after the fungus clears.

How to cure white spots on toenails?

White spots on toenails are often from minor knocks and grow out on their own over months. A chalky white patch on the surface can be a shallow fungal infection, which usually responds to a lacquer or cream. If spots spread, thicken or do not grow out, ask a doctor for a clipping test to find the cause. The symptoms of fungal nails are thickening, a yellow or white colour, crumbling edges and lifting.

Can a doctor prescribe treatment of fungal toenail online?

A Medio doctor can assess your toenail by phone, ask for photos sent securely, and send a pathology request for a nail clipping test. Where the result confirms fungus and the doctor thinks it right, they can send an eScript for tablets, with a blood test if needed, or refer you to a podiatrist. The doctor cannot examine the foot, so pain, redness or a dark streak needs an in person check.

Does laser treatment work for toenail fungus?

Laser can improve how a nail looks, but it cures fewer people than tablets and the evidence is limited. Hot lasers have more evidence behind them than cold ones, and does laser treatment for fungal nail infections hurt? Most people feel warmth or a pinprick only. It is paid for privately, has no Medicare rebate and works best with a lacquer.

Is hydrogen peroxide good for toenail fungus?

Hydrogen peroxide is not a proven treatment for toenail fungus. It may lighten the surface of the nail but does not reach the fungus underneath, and repeated soaking can irritate the skin. A pharmacy lacquer, or tablets on a doctor's advice, are the treatments with evidence behind them.

How do Japanese treat toenail fungus?

Japanese doctors treat toenail fungus with the same main approaches used in Australia, antifungal tablets and medicated nail solutions, and some topical solutions developed in Japan are not sold here. Taking shoes off indoors and keeping feet dry are part of daily life there, which helps keep feet clear. What causes fungal nail infections, how they spread and whether they are contagious is the same everywhere: the fungus passes through damp floors and shared items, and treating it early works best.