Slow to treat and worth confirming before you start — half of thickened nails are not fungal.
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Fungal nail infection makes nails thickened, discoloured, brittle and crumbly. It is common, particularly in toenails, and it is treatable — but it is one of the areas where the standard approach most often goes wrong.
The most important point on this page: get it confirmed before treating it. Up to half of thickened, discoloured nails are not fungal at all. Repeated trauma from footwear, psoriasis and other nail conditions look very similar. Months of oral antifungal treatment for a nail that was never infected achieves nothing and carries real risk, so a nail clipping sent for laboratory testing is worth the wait.
Second: the nail does not look better when the treatment works. The infection is killed, but the damaged nail has to grow out — and a toenail takes 12 to 18 months to replace itself completely. People finish a three-month course, see a nail that looks unchanged, and conclude it failed. It usually has not.
And third: treatment is optional. If the nail does not hurt and does not bother you, leaving it alone is entirely reasonable — unless you have diabetes or poor circulation, where it matters more.
Athlete's foot, almost always — and it needs treating at the same time, or the nail keeps being reinfected.
A dark brown or black streak running lengthways along a single nail — particularly if it is widening, if the nail is distorting, or if the pigment extends onto the skin of the cuticle. This can be a melanoma of the nail unit and needs urgent assessment. It is not fungal, and it should never be treated as such or left to see if it grows out.
Usually a dermatophyte — the same fungus family as athlete's foot and ringworm. Occasionally yeasts, particularly in fingernails, or moulds.
The infection nearly always spreads from the skin of the foot to the nail, which is why treating the nail without the skin fails.
For most people this is a cosmetic problem. It is not, however, for everyone:
In those situations treatment is a health measure rather than an appearance one.
Send nail clippings for microscopy and culture before starting treatment. Up to half of abnormal-looking nails are not fungal, and oral treatment lasts months, requires blood monitoring and interacts with other medicines. It is not something to commit to on appearance alone.
Take the sample before starting any treatment — including nail lacquers — or the result may be falsely negative. Clip as far back as you can and include the crumbly debris from underneath, which is where the fungus is; the shiny clipped edge alone often comes back negative. Results usually take two to four weeks, and culture is imperfect, so a repeat sample is sometimes needed.
No treatment is a perfectly reasonable option if the nail is painless and does not bother you. Oral treatment means months of tablets and blood tests for what is, for most people, an appearance problem. That is a trade-off worth making deliberately.
It shifts where there is diabetes, poor circulation, immunosuppression, pain, or spreading infection — there, treatment is worthwhile on health grounds.
Amorolfine nail lacquer, applied once or twice weekly for six to twelve months.
Cure rates are low — well under a third — and it works best only for early infection affecting the tip of one or two nails, without involvement of the base. We would rather say that plainly than have you spend a year on something unlikely to work. Filing the nail surface before applying helps it penetrate.
Your nail will look no better at the end of the course. The fungus is killed but the damaged nail must grow out — 12 to 18 months for a toenail. Judge success by whether healthy nail is emerging from the base, not by the appearance of the tip. This is the single commonest reason people believe treatment has failed.
Treat athlete's foot at the same time and keep treating it afterwards. Recurrence rates are high, and untreated skin infection is the usual reason.
Fungal nail infection is not an emergency. Seek prompt medical attention for:
Book an appointment for:
Repeated trauma from shoes that are slightly too short both damages nails and lets fungus in. Have your feet measured — particularly if you run — and allow a thumb's width at the end.
Check your feet daily, see a podiatrist for nail care rather than cutting thickened nails yourself, never use over-the-counter corn or hard-skin removers, and get any break in the skin looked at promptly.
The first question is whether to treat this at all, and for many people the honest answer is no. A discoloured toenail causing no symptoms in an otherwise healthy person is a cosmetic problem, and the treatment is three to six months of tablets with blood tests. Doing nothing is a legitimate choice and we will say so.
NHS treatment is free where it is indicated, though many practices now decline to treat purely cosmetic nail infection.
Where money is genuinely wasted: medicated nail lacquers, which are expensive over a year and have poor cure rates for established infection; laser treatment, where durable cure evidence is weak; and tea tree oil, vinegar soaks and Vicks, none of which clear an established nail infection.
Where a consultation is worth paying for is doing it properly — nail clippings sent for confirmation before starting, because roughly half of abnormal nails are not fungal at all, plus baseline liver function tests and a medicines review, since terbinafine raises the levels of several drugs.
Treatment matters more if you have diabetes or poor circulation, where nail and skin infection is a route to more serious foot problems.
NICE Clinical Knowledge Summary, Fungal nail infection, is the principal reference. It recommends confirming the diagnosis by nail clipping and mycology before starting oral treatment, since a substantial proportion of dystrophic nails are not fungal, and covers terbinafine as first-line for dermatophyte infection.
CKS specifies treatment durations — six weeks to three months for fingernails, three to six months for toenails — and notes that the nail appearance continues to improve for months after treatment ends.
CKS recommends baseline liver function testing before oral terbinafine, with repeat testing for longer courses.
CKS is explicit that treatment is not always necessary, and that asymptomatic infection in a healthy person may reasonably be left — the basis for the position above.
British Association of Dermatologists guidelines cover topical amorolfine, restricted to early superficial disease affecting a limited portion of the nail.
Not necessarily — up to half of thickened, discoloured nails are not fungal. Repeated trauma from footwear and psoriasis both look very similar. This matters because oral treatment means months of tablets, blood tests and drug interactions. Get a nail clipping tested before committing to any of that, and take the sample before starting any treatment.
Because that is expected. The treatment kills the fungus but the damaged nail has to grow out, and a toenail takes 12 to 18 months to replace itself. Judge it by whether healthy nail is appearing at the base, not by the tip. This is far and away the commonest reason people think treatment failed when it did not.
Rarely, if the infection is established. Cure rates for amorolfine lacquer are well under a third, and it only really works for early infection at the tip of one or two nails without involvement of the base. We would rather tell you that than take a year of your effort. Filing the nail surface first helps a little.
No. If the nail is painless and does not bother you, leaving it is entirely reasonable — months of tablets for an appearance problem is a real trade-off. It becomes more important if you have diabetes, poor circulation or a weakened immune system, where thickened nails and athlete's foot together can lead to skin breaks and infection.
Almost always because the skin was not treated. Athlete's foot is the reservoir — treat it alongside and keep treating it. And use an antifungal powder inside your shoes: fungal spores survive in footwear for months, and this step is nearly always missed.
Not usually, and it needs looking at rather than treating. A brown or black lengthways streak in a single nail — especially one that is widening, distorting the nail, or spreading onto the skin at the cuticle — can be a melanoma of the nail. Please get it assessed promptly rather than waiting to see whether it grows out.
Not while you are treating them — varnish, gel and acrylics all seal moisture against the nail and work against you. Once treatment is finished and healthy nail is growing, it is fine. And at a salon, check the instruments are properly sterilised between clients, or take your own — nail bars are a genuine source of infection.
August 23, 2026
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