Fungal Nail Infection: What Actually Works and How Long It Takes

Thick, yellow or crumbly toenails are one of the things people most often show us at the counter, usually a little embarrassed. A fungal nail infection is not serious, but it is slow to shift. The NHS puts it plainly: these infections can take a long time to treat. This guide explains how to tell whether a pharmacy treatment is likely to suit you, how to use a medicated nail lacquer so it has the best chance of working, how long it really takes, and when it is better to see a GP.

What is a fungal nail infection?

A fungal nail infection (the medical name is onychomycosis) happens when fungi get into the nail. Most are caused by the same group of fungi, called dermatophytes, that cause athlete's foot, which is why the two so often turn up together. Toenails are affected far more often than fingernails, and the infection becomes more common as we get older, according to the British Association of Dermatologists.

Warm, damp feet give the fungus what it likes. Long days in trainers, sweaty socks and communal showers at the gym or in student halls all raise the chances. The typical signs, as described by the NHS, are:

• a nail that turns white or yellow, usually starting at the edge and spreading across
• a nail that becomes thicker than usual, or brittle and crumbly
• in more advanced cases, the nail lifting away from the skin underneath, sometimes with pain or swelling around it

Not every discoloured or thickened nail is fungal. Psoriasis and old injuries can look very similar, which is why the dermatologists' leaflet recommends testing a piece of nail before longer courses of treatment. If you are unsure what you are looking at, that is a good reason to show us the nail rather than guess.

Is a pharmacy nail lacquer right for you?

The medicines you can buy from a pharmacy for fungal nails are antifungal nail lacquers, a medicated "paint" you brush onto the nail. The ones we stock contain amorolfine 5%. They are licensed for a specific situation: a mild infection, in an adult, affecting no more than two nails, where only the top half or the sides of the nail are affected. That comes straight from the product information for Curanail 5% nail lacquer and its patient leaflet. Always read the leaflet in your own pack too: it is the licence for that exact product.

If one of the right-hand boxes applies to you, the infection is not necessarily worse, but the lacquer is not licensed for your situation and a GP is the right first step. The NHS also advises seeing a GP if the infection is severe, has spread to other nails, or has not improved with pharmacy treatment. People with diabetes, in particular, should never self-treat foot problems without advice: small problems on the feet matter more when circulation or healing is affected.

How amorolfine 5% medicated nail lacquer works, step by step

Amorolfine is an antifungal medicine that you paint onto the nail. It is applied once a week, not every day, and the product information is specific about the method (Curanail official product information, section 4.2). Getting the routine right matters more than anything else you can do.

1. File the affected nail. Before the first application, gently file down the infected part of the nail, including the surface, as thoroughly as you can. Use the files supplied and do not use them on healthy nails.
2. Clean it. Wipe the nail with one of the cleaning pads in the pack to remove grease, so the lacquer sticks.
3. Paint the whole nail. Dip the applicator into the bottle and brush the lacquer evenly over the entire nail. Keep it off the skin around the nail.
4. Let it dry. Allow about three minutes. Clean the applicator with the same pad afterwards.
5. Repeat weekly. Before each weekly application, file again if you need to and clean the nail.

A few practical points from the patient leaflet: you can wear cosmetic nail varnish, but wait at least ten minutes after applying the lacquer and remove the varnish before your next weekly dose. Do not use artificial nails during treatment. If you use solvents such as white spirit or paint thinners, wear impermeable gloves so the lacquer is not stripped off.

What about other nail treatments on the shelf?

You will also see products such as Scholl Fungal Nail Treatment. It is a different kind of product: it is classed as a medical device rather than a medicine, and it is used according to its own instructions. It is not a substitute for a GP assessment if any of the "see a GP first" points above apply. Antifungal creams, meanwhile, are made for skin, such as athlete's foot between the toes, rather than for the nail itself. If you have athlete's foot as well, the NHS advises treating it promptly, because it can spread to the nails.

How long does treatment take?

This is where most people give up too early. The lacquer treats the fungus, but the damaged part of the nail does not repair itself: it has to grow out and be replaced by healthy nail from the base, and nails grow slowly. The product information gives the typical course as around six months for fingernails and nine to twelve months for toenails, with a review roughly every three months (Curanail official product information). The NHS says it can take several months before you see any improvement at all.

The patient leaflet builds in two checkpoints. Every three months, look at the nail honestly: if it is improving, carry on; if it looks the same or worse, talk to your pharmacist or doctor rather than just keeping going. And if the nail is still infected at the end of the usual course, six months for a fingernail or twelve months for a toenail, see a doctor. Even then, a clear nail is not a promise it stays that way. The dermatologists point out that re-infection is common, so the prevention habits further down are part of the treatment, not an afterthought.

Side effects and when to stop

Side effects are uncommon. The product information lists rare nail changes such as discolouration or brittle nails, and very rarely a burning feeling on the skin. Stop using the lacquer and get help straight away if you notice signs of an allergic reaction, such as swelling of the face, lips or throat, or difficulty breathing.

Suspected side effects from any medicine can be reported through the MHRA Yellow Card scheme. We are happy to help you do it.

When a GP is the better route

A GP can arrange for a small piece of nail to be sent to a laboratory to confirm the infection and identify the fungus, and can prescribe antifungal tablets for more widespread or severe infections. The NHS explains that tablets can be needed for several months and that blood tests may be used to check the liver during treatment; tablets are not suitable for everyone. In a small number of severe cases, removing the nail is an option. We cannot supply antifungal tablets for nails at the pharmacy, which is why we will point you to your GP when that is the right route rather than sell you a lacquer that is unlikely to work.

Preventing it coming back

These habits come from the NHS and the dermatologists' advice. They are simple, but they are what stops a treated nail becoming re-infected:

• treat athlete's foot as soon as you notice it, so it does not spread to the nails
• keep your nails short, clean and dry, and dry properly between your toes after washing
• wear clean cotton socks every day and shoes that fit well; give trainers a chance to dry out
• wear flip-flops in communal showers and changing rooms
• do not share towels, shoes or nail scissors and files
• consider throwing away old, worn shoes that may be carrying the fungus

How we can help at Hyde Park Pharmacy

We are on Woodsley Road, a few minutes from Hyde Park and the university campuses. You are welcome to come in and show us the nail. The pharmacist can take a look, ask a few questions about your health, and talk you through whether a pharmacy lacquer is likely to suit you or whether a GP appointment makes more sense. No appointment is needed.

If you already know what you need, the amorolfine 5% medicated nail lacquer and Curanail 5% nail lacquer are both available from us, and you can see everything we keep on our nail infection page. Both are general sale medicines, so there is no questionnaire to fill in, and our pharmacist still reviews every order before it is sent. If you are not sure it suits you, or you have diabetes, poor circulation or a weakened immune system, ask us first - a GP may be the safer route.

Frequently asked questions

This is general information. Always consult a qualified healthcare professional before starting any new treatment.