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One of the best parts of my job is writing about impressive cutting-edge medical treatments, from heart transplants<\/a> to techniques that let us rewrite our genetic code<\/a>.<\/p>\n But modern medicine seems to be stumped when it comes to tackling a more humble foe: toenail fungus.<\/p>\n New FeatureIn ShortQuick Stories. Same trusted journalism.<\/p>\n A fungal infection<\/a> of the toenails is incredibly common, affecting one in four people \u2013 and yet, while there are a range of nail treatments and tablets that are claimed to work, they are in fact woefully ineffective.<\/p>\n But if you are one of those affected, don\u2019t give up. Here\u2019s the latest advice on the best current treatments to use \u2013 plus what might be around the corner.<\/p>\n The current treatments<\/p>\n The first sign of fungal infection may be a small area at the top or sides of the nail becoming white or yellow. Once it has this, ahem, toehold, the infection tends to progress, with the affected area growing, and getting thicker and more brittle.<\/p>\n The fungus is usually the same one that causes \u2018athlete\u2019s foot\u2019, when the skin between the toes or on the soles goes dry and flaky and can eventually develop painful cracks.<\/p>\n While athlete\u2019s foot is usually easy to cure with antifungal creams or powders, once the infection has spread to the nails, it is a whole different ballgame.<\/p>\n Now the fungus is cosily ensconced on the skin underneath the toenails. And so, those athlete\u2019s foot creams can\u2019t reach it. \u201cThe nail is protecting it from the outside world,\u201d said Dr Ivan Bristow, a spokesperson for the Royal College of Podiatry.<\/p>\n The first thing a pharmacist usually recommends is a nail varnish that contains an antifungal drug called amorolfine. But this is no easy fix. The varnish has to be reapplied every week for many months, for up to a year.<\/p>\n And even so, the cure rate is low, at 15 to 30 per cent, according to the British Association of Dermatologists<\/a>. It is more likely to work in milder cases.<\/p>\n The chief problem is that the varnish is applied to the surface of the nail and so only low amounts reach the nail bed. People are advised to use a nail file on the surface of the nail to reduce its thickness, and also use clippers to make the nail as short as possible, to reduce the \u201cfungal load\u201d.<\/p>\n If varnish doesn\u2019t work, the next step is usually to try oral medication, which gets the antifungal drugs into the nail via the bloodstream.<\/p>\n The first recommended treatment is a medicine called terbinafine, which has to be taken for three months. But this has drawbacks too. It can occasionally cause liver damage and so people need a blood test before starting treatment to check their liver is in good shape.<\/p>\n They are also supposed to avoid alcohol<\/a> for the entire three months of treatment, to avoid raising the risk of liver damage \u2013 which puts some people off. And cure is still not guaranteed, with the success rate at 50 to 80 per cent.<\/p>\n New cures<\/p>\n With these limitations, it is unsurprising researchers are looking for better options. One that may arrive soon is a varnish form of terbinafine, which gives the higher cure rate of this drug with less chance of liver damage. \u201cFor the first time, we\u2019ll have a terbinafine-based nail treatment,\u201d said Dr Bristow.<\/p>\n The varnish is currently available only in some European countries but the manufacturer has recently signed a contract with a UK distributor.<\/p>\n Another option is laser treatment, available at some podiatrists. The focused light beams can penetrate the toenail but are absorbed by pigments in the fungal cells, generating heat \u2013 which kills them.<\/p>\n Laser treatment is usually given once a week or fortnight and needs several applications, depending on how severe the infection is.<\/p>\n It is not yet clear how well laser treatment works. In fact, the next edition of the British Association of Dermatology guidelines on toenail fungus, due out in a few months, will say there isn\u2019t yet enough evidence to show it is better than oral terbinafine, and it is more expensive, said co-author Dr Bristow.<\/p>\n Marion Yau, a podiatrist at Harley Medical Foot and Nail Laser Clinic, says laser treatment can have an 80 per cent success rate if it is combined with removing as much of the nail as possible, even the whole nail in severe cases.<\/p>\n Another option is in the works that seems almost too good to be true \u2013 as it is claimed to eradicate the fungus in 24 hours<\/a>.<\/p>\n This is a gel placed on the nail that releases hydrogen sulphide \u2013 a toxic gas that smells like rotten eggs \u2013 which is a small enough molecule to pass clean through the nail. Fortunately it is not created at high enough concentrations to be harmful, or even odorous, say the developers.<\/p>\n \t\tYour next read<\/p>\n![\"A](\"https:\/\/www.newsbeep.com\/uk\/wp-content\/uploads\/2026\/02\/SEI_285688331.jpg\")
For serious cases of fungal toenails, see a podiatrist (Photo: pedro arquero\/Getty Images\/Moment RF)<\/p>\n
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