Fungal nail infection - Treating a fungal nail infection

Treatment may not be necessary in mild cases of fungal nail infection.

But if you don't treat the infection, there's a chance it will spread to other nails.

Using simple self-care methods may be effective in some cases. For example, not wearing footwear that makes your feet hot, keeping your nails short and maintaining a high level of foot hygiene can help prevent fungal nail infections.

Medication

Medication may be recommended if your fungal nail infection is more severe. Antifungal medicines, such as tablets and nail paints, are the two main treatments.

Your GP and pharmacist will be able to advise you about whether you need treatment and, if so, recommend the type you need.

Your nail's appearance may not return to normal after the infection has cleared. However, a sample of your nail should be tested if it still looks infected.

Antifungal tablets

Taking antifungal medication in the form of tablets means that the treatment reaches your nail through your bloodstream.

Terbinafine and itraconazole are the two medicines most commonly prescribed for fungal nail infections and they can be very effective.

However, you may have to take the tablets for several months to ensure that the infection has completely cleared up. If you stop taking the medication too early, the infection may return.

An advantage of using antifungal tablets is that they'll also clear up any associated fungal skin infections, such as athlete's foot, at the same time.

However, side effects of antifungal tablets can include:

headache
itching
loss of sense of taste
nausea
diarrhoea

Antifungal nail paint

If you prefer not to take antifungal tablets, your GP may suggest you try antifungal nail paint instead.

Nail paint isn't considered to be as effective as tablets because it's painted onto the infected nail and has to work its way through to the infection. It can often be difficult to reach all of the infection.

A fingernail may need around six months of treatment, and a toenail may take up to 12 months.

Chemical nail removal

The abnormal infected nail plates can be removed using a paste containing 40% urea (a chemical that occurs naturally in the body which can also be manufactured). The paste is available over the counter from pharmacies.

You carefully apply the paste to the affected nails, which are covered and left overnight. You then wash the paste off in the morning and repeat the process each night after filing down the nail as instructed. It usually takes about two weeks to dissolve the nail plates.

Chemical nail removal is a painless treatment that gradually removes the abnormal nail plate and the fungus. It allows you to avoid taking tablets for several months and avoid surgery, which can be painful.

Once the nail plates have been dissolved, antifungal nail paint should be applied to the nails twice a week to prevent the nails being reinfected as the new nail forms.

Surgery and laser treatment

Surgery to remove the infected nail may be recommended if your infection is very severe or painful and other treatments have proved ineffective.

If your nail is surgically removed, a new nail should eventually grow back in its place. However, it could take a year or more for the nail to grow back completely.

Laser treatment is another possible option if you have a fungal nail infection that's particularly stubborn. The laser emits high doses of light energy, which are used to destroy the fungus.

Research shows that laser treatment is a safe and effective procedure, with some studies reporting a success rate of up to 90% at three months.

However, there's currently little evidence to show that laser treatment provides a long-term cure, as most studies only follow patients up for a period of three months.

To achieve these high success rates, you need to be treated every three months for up to a year. As laser treatment is only available privately, this could prove expensive.

Foot care during treatment

During your treatment, you should see a new healthy nail start to grow from the base of your nailbed. This is a sign that the treatment is working. The old infected nail should begin to grow out and can be clipped away over the course of a few months.

Speak to your GP if a new nail doesn't start to grow after two to three weeks of treatment. Keep using the treatment until your GP says you can stop. Stopping too early could result in the infection returning.

Foot care tips

There are some things you can do to help keep the infection at bay during and after treatment. These are listed below.

keep your feet cool and dry, and wear shoes and socks that allow your feet to breathe
wear clean cotton socks and avoid wearing trainers
treat athlete's foot with antifungal medicine as soon as possible to avoid the infection spreading to your nails
clip your nails to keep them short
use a separate pair of clippers or scissors to cut the infected nail to avoid spreading the infection to other nails
wear well-fitting shoes without high heels or narrow toes
maintain good foot hygiene
wear clean shower shoes when using a communal shower
consider seeking treatment from a podiatrist if thickened toenails cause discomfort when walking
consider replacing old footwear as it could be contaminated with fungal spores

Read more about how to keep your feet healthy.