In short: topical lacquers used alone clear little more than mild infection at the very tip of the nail, oral antifungal tablets work better but need a GP prescription, months of dosing and carry side effects, and laser treats the nail directly with no drugs and no needles. At Podiatry Healthcare Group we see around 85% success with the FDA-cleared GenesisPlus Nd:YAG 1064nm laser after two to three sessions. Whichever route you take, killing the fungus is only half the job, because a toenail takes roughly 9 to 12 months to grow out before it looks normal again.
Why are fungal nails so hard to treat?
A fungal nail infection does not sit on top of the nail. It lives in and under the nail plate, in the nail bed and in the deeper layers of keratin. The nail plate is a dense barrier built to keep things out, and it does that job just as well against a treatment as against anything else.
That is why most topical products struggle. They are painted onto a structure designed not to absorb, with the fungus on the other side of it. Tablets take the long way round, travelling through the bloodstream and depositing into new nail as it forms, which is why they are taken for months rather than days.
Two other things work against you. Toenails grow slowly, so nothing looks better quickly, and the inside of a shoe is warm, dark and damp.
Is it definitely fungal?
This is the step people skip, and it costs them months. Not every thick, crumbly or discoloured nail is fungal. Repeated trauma does the same thing and is common in runners whose nail knocks the end of the shoe. Psoriasis, old bruising underneath and pressure from tight footwear all look similar to the untrained eye.
An assessment starts with the pattern: how many nails are involved, where the change began, whether the skin between the toes is flaking, whether there was an injury. Where the picture is not clear, a nail sample can be sent for testing before you commit to a long course of treatment.
The skin is often the reservoir, too. Tinea between the toes feeds the nail infection, and treating one without the other is a good way to end up back where you started.
The three real options, compared honestly
Topical lacquers and creams
These are cheap, need no prescription and are easy to apply. Their weakness is penetration. Used on their own they have low success rates, and those rates fall further once the infection has travelled past the tip toward the cuticle, or once the nail is badly thickened.
They are not useless. They have a role in very early tip-only infection, alongside other treatment, and on the surrounding skin. Results improve when we reduce and thin the nail first, so there is less material for the product to get through.
Oral antifungal tablets
Tablets reach the nail from the inside and outperform topicals. They need a prescription from your GP and are taken for months rather than weeks, because they only protect nail that has not grown yet.
The trade-off is side effects. Headaches and stomach upset are the common ones, and liver damage is rare but serious enough that your GP may want blood tests. Tablets also interact with a number of other medicines, so they are not suitable for everyone and the decision belongs with your GP, who knows your full history.
Laser
We use the FDA-cleared GenesisPlus Nd:YAG 1064nm laser. The wavelength passes through the nail plate and delivers heat to the nail and nail bed where the fungus is actually living, so nothing has to be absorbed through the nail or travel through your bloodstream.
There are no drugs, no needles and no downtime. Most people describe a warm sensation and nothing more, then put their shoes back on and walk out. We see around 85% success after two to three sessions. It suits people who cannot take oral antifungals, who have tried a lacquer without success, or who would rather not commit to months of tablets. There is more detail on our fungal nail laser treatment page.
Why won’t my nail look normal straight away?
This is the most misunderstood part of fungal nail treatment. Killing the fungus does not repair the nail. Damaged nail does not heal, it grows out, and a toenail takes roughly 9 to 12 months to replace itself from base to tip.
So we do not judge success by how the whole nail looks. We judge it at the cuticle. A clear band of new growth from the base is the signal that treatment has worked, even while the old damaged portion sits further up waiting to be trimmed away. Take a photo on day one and compare from the same angle every couple of months.
Where an infection has been present for years, or where there was old trauma, the nail matrix itself may be permanently marked, so the nail can grow out clear of infection but stay slightly ridged.
How do you stop it coming back?
Reinfection is why people clear a nail and find themselves back a couple of years later. The habits matter as much as the treatment.
- Treat the skin, not just the nail. Flaking or itchy skin between the toes needs its own attention.
- Dry between the toes after showering, not just over the top of the foot.
- Rotate your shoes so each pair dries out, and use an antifungal powder or spray inside them.
- Wash socks hot and choose materials that move moisture rather than hold it.
- Wear thongs in public showers, gym change rooms and around pools.
- Keep your own clippers and file, clean them, and do not share them with the household.
- Skip the polish while you are being treated. It traps moisture and it hides the new growth you are trying to measure.
If you have diabetes, reduced circulation or reduced sensation, have any nail or skin change checked early rather than watching it, which is what our diabetic foot care assessments are for. The same laser also treats plantar warts, and thickened nails often bring ingrown toenail trouble that is easier to sort out at the same visit.
Common questions
Does laser treatment for fungal nails hurt?
No. It is needle-free, and most patients feel nothing more than a warm sensation over the nail. There is no downtime, so you put your shoes back on and go straight back to your day.
How many sessions will I need?
We see around 85% success after two to three sessions. What suits you depends on how many nails are involved and how far the infection has travelled, which we work out at your assessment rather than guess in advance.
Can I use laser and tablets or a lacquer together?
Yes, and combining approaches is common. Laser handles the nail, a topical helps keep the surrounding skin clear, and if your GP has prescribed tablets there is no reason to stop them. Tell us what you are already using.
Do I need a referral to be seen?
Only DVA Gold Card holders and WorkCover patients need a referral. Everyone else can book directly. If you have a chronic condition such as diabetes, your GP may be able to arrange a Medicare Enhanced Primary Care plan, and we have HICAPS at every clinic for private health rebates on the spot.
How will I know it is working?
Watch the base of the nail, not the tip. A clear band growing from the cuticle means the treatment has worked, even though the damaged section further up needs the rest of the 9 to 12 month growth cycle to be trimmed away.
If you are not sure which option fits your nails and your medications, book an assessment at any of our four Melbourne clinics, or read more in our foot health section.
This page is general information, not personal medical advice. Reviewed by Gideon Poratt, Principal Podiatrist (B.App.Sc (Pod), M.A.Pod.A), a member of the Australian Podiatry Association. Please book an assessment for advice specific to your feet.