Fungal Toenail Treatment
Thick, yellow, crumbling toenails are one of the most common things we see, and one of the most frustrating things people try to treat themselves. Creams and lacquers from the chemist struggle to get through a thickened nail plate to where the fungus actually is, which is why so many people have spent a year painting something on with nothing to show for it.
We offer laser therapy through our sister clinic, The LaserCare Clinic. But we start somewhere else.
Start with the diagnosis, not the treatment
Plenty of toenails that look fungal are not. Old trauma thickens and discolours a nail in exactly the same way. So does psoriasis, chronic pressure from footwear, and several other conditions. Bacterial infection produces its own distinct discolouration.
This matters for one simple reason: antifungal treatment does nothing at all for a nail that does not have a fungal infection. People spend months and real money on creams, lacquers and tablets for a nail that was never going to respond to any of them.
So we look at the nail properly first, and if the diagnosis is not clear we say so and tell you what would settle it.
Laser therapy
Where the nail is confirmed as fungal, the laser passes through the nail plate and heats the tissue beneath it, targeting the fungus in the nail bed that topical treatments struggle to reach through a thickened nail.
It is non-invasive. There are no tablets, no liver function tests and no interaction with other medication, which is the usual reason people are steered away from oral antifungals in the first place. Most people describe it as a sensation of warmth.
You should expect a course of sessions rather than a single visit. We will tell you how many at the consultation, based on how many nails are involved and how far the infection has gone.
What results look like, honestly
Nobody can clear a fungal nail instantly, with any treatment, because the nail you can see is already grown. What changes is the new nail coming through behind it, and on a toe that advances slowly, roughly one millimetre a month.
That means a toenail can take twelve to eighteen months to grow out fully. It is a long game, and anyone promising you a clear nail in weeks is not being straight with you.
We will not promise a guaranteed cure either. The published evidence on laser treatment of fungal nails reports improvement in the appearance of the nail rather than a certainty. What we will do is tell you honestly what we expect in your case, and tell you if we think you are unlikely to get value from it.
Reducing the nail first
Where a nail is very thick, reducing and thinning it professionally is often worth doing regardless. It relieves pressure pain in a shoe immediately, it makes the nail easier to manage, and it gives any treatment a better chance of reaching the nail bed.
Keeping it from coming back
Fungal nail infection usually does not arrive on its own. It commonly comes from athlete’s foot, from shared floors in changing rooms and pools, from damp footwear, or from a nail that was damaged and gave the fungus a way in.
Treating the nail and leaving the source untouched is how people end up doing this twice. We look at the whole foot, and if the fungus has also reached your fingernails, see fungal fingernail treatment.
Worth knowing. A single dark or discoloured nail with no history of injury should always be assessed by a doctor rather than simply treated as fungal. In the overwhelming majority of cases it is harmless. It is checked because of the small number of cases where it is not.
Common questions
How do I know if it is actually fungal?
You often cannot tell by looking, and neither can anyone else without examining it. That is the point of the consultation.
Does the laser hurt?
No anaesthetic is needed. Most people feel warmth and nothing more.
How many sessions will I need?
It depends on how many nails are involved and how advanced the infection is. We give you a number at the consultation rather than a vague answer now.
How long before I see a difference?
You are waiting for clear nail to grow out from the base, at roughly one millimetre a month on a toe. Full growth out commonly takes twelve to eighteen months. You will see clear nail appearing at the base long before that.
Can I wear nail polish during treatment?
Ask us at the consultation, because it depends on the stage of treatment.
What about the tablets my GP mentioned?
Oral antifungals are effective for many people and are a legitimate option. They need blood test monitoring and they interact with a number of common medicines, which is why some people cannot take them. That is a conversation for you, us and your GP, and we will not pretend the laser is the only answer.