Fungal Nail Treatments Compared
Lacquer, tablets, softening kits and cream — what each is actually for, what tablets involve, and how to tell whether any of it is working.
Part of the Complete Fungal Nail Infection Guide.
Key fact: Lacquer only reaches so far. It is for early infection in one or two nails that has not reached the growing base. Once the base is involved or several nails are affected, months of lacquer will not clear it — and that is the commonest reason treatment "fails".
How the choice is made
Not by severity of appearance, but by how far back the infection goes and how many nails are involved.
| Situation | Usual approach |
|---|---|
| Early infection, distal or superficial, one or two nails, growing base unaffected | Topical lacquer |
| More than about half of a nail involved, or several nails | Oral treatment |
| Infection reaching the base of the nail (the matrix) | Oral treatment — lacquer cannot reach it |
| Topical treatment already tried and failed | Reassess the diagnosis, then consider oral treatment |
| Diabetes, poor circulation or immunosuppression | Assessment rather than self-treatment |
| Fingernails | Either, but both work faster than on toenails |
Antifungal nail lacquer
Amorolfine 5% is the standard topical option, sold as amorolfine nail lacquer, Curanail and Loceryl — the same active ingredient at the same strength.
- Applied once or twice weekly, not daily
- File the nail surface first with the files provided, and clean with the supplied swab. This is not optional — it is how the lacquer gets in
- Use a separate file for infected nails and throw it away, to avoid spreading it
- Continue for 6 months for fingernails, 9 to 12 months for toenails
- Avoid nail varnish over the top unless the product says otherwise
- Side effects are uncommon and usually limited to mild irritation around the nail
Its limitation is penetration. Lacquer treats the nail plate and the surface beneath it; it does not reach infection sitting at the growing base.
Antifungal tablets
Terbinafine 250mg once daily is the usual first-line oral treatment for dermatophyte nail infection — the great majority of cases.
| Fingernails | Toenails | |
|---|---|---|
| Typical course | About 6 weeks to 3 months | About 3 to 6 months |
| Why the difference | Fingernails grow roughly two to three times faster | A toenail takes 12 to 18 months to replace itself |
Itraconazole is used instead where the infection is caused by Candida or a non-dermatophyte mould, or where terbinafine is unsuitable. That is a prescriber's decision and depends on what the laboratory grew, which is one of the practical arguments for sampling first.
What tablets involve
- Liver function blood tests are usually checked before starting and again about a month in, and treatment is stopped if results are abnormal
- Taste disturbance is a recognised effect of terbinafine — food tasting metallic or bland. It usually recovers after stopping, though it can take weeks
- Stomach upset, headache and rash are the common side effects
- Drug interactions matter, so give a full list of what you take, including anything bought over the counter
- Not suitable in some situations — existing liver disease, pregnancy and breastfeeding among them
Stop and seek advice promptly if you develop yellowing of the skin or eyes, dark urine, pale stools, persistent nausea, unexplained tiredness or abdominal pain — or a widespread or blistering rash. Serious liver reactions to terbinafine are rare but are the reason monitoring exists.
Nail softening and removal
Kits such as Scholl fungal nail treatment work differently: they soften and gradually remove the infected part of the nail, then treat what is exposed. They suit thickened nails where the bulk of diseased nail is itself the obstacle, and they are often used alongside other treatment rather than instead of it.
In severe cases a badly infected nail is occasionally removed surgically under local anaesthetic, though this is uncommon and does not on its own cure the infection.
Cream for the skin
Terbinafine 1% cream treats the athlete's foot, not the nail — cream does not penetrate a nail plate. It matters here because the skin is what reinfects the nail, so treating one without the other tends to fail.
Skin usually clears in one to two weeks, though treatment is often continued a little longer to prevent it returning. Athlete's foot and reinfection covers this properly.
How well each works
~5 in 10treated nails end up looking fully normal
2 in 10clear the fungus but the nail still does not look right
1 in 4cleared infections return within three years
Lacquer alone has substantially lower cure rates than tablets, which is the reason it is reserved for early, limited disease rather than tried first in every case. Being told the realistic figure at the start makes people considerably more likely to finish a course.
Judging whether it is working
Look at the base of the nail, not the end. The damaged part will never recover — it has to grow out. The sign of success is clear, healthy nail emerging from the cuticle and advancing. If you can see a clean band growing in, the treatment is working, however bad the far end still looks.
Marking the boundary between healthy and damaged nail with a small file notch, and watching it move towards the tip over months, turns an invisible process into something you can actually track.
If it is not working
| Possibility | What to do |
|---|---|
| It was never fungal | The commonest explanation. See is it really a fungal nail? |
| Too early to tell | Toenails need 9 to 12 months of lacquer, and appearance lags behind cure |
| Wrong treatment for the extent | Lacquer on infection that has reached the nail base will not clear it |
| Reinfection from the skin | Untreated athlete's foot, or shoes kept from during the infection |
| A non-dermatophyte organism | Candida and moulds respond differently, which sampling identifies |
| Application technique | Lacquer applied without filing first penetrates far less |
Frequently Asked Questions
Is nail lacquer or are tablets better for a fungal nail?
It depends on how far the infection goes rather than how bad it looks. Lacquer suits early, superficial or distal infection in one or two nails where the growing base is unaffected. More extensive infection, several nails, or infection reaching the nail base needs oral treatment, because lacquer cannot penetrate that far.
How long do you take terbinafine for a nail infection?
Around 6 weeks to 3 months for fingernails and 3 to 6 months for toenails. The difference is growth rate: fingernails grow roughly two to three times faster, and a toenail takes 12 to 18 months to replace itself entirely.
Do you need blood tests with antifungal tablets?
Liver function is usually checked before starting terbinafine and again about a month into treatment, with treatment stopped if results are abnormal. Seek advice promptly for yellowing of the skin or eyes, dark urine, pale stools, persistent nausea or unexplained tiredness.
Are Curanail, Loceryl and amorolfine the same?
Yes, in active ingredient. All are amorolfine 5% nail lacquer, applied once or twice weekly after filing the nail surface, for 6 months on fingernails and 9 to 12 months on toenails. They differ in brand and price rather than in what they contain.
How do I know the treatment is working?
Look at the base of the nail rather than the end. The damaged part never recovers and has to grow out, so success looks like clear healthy nail emerging from the cuticle. Marking the boundary with a small file notch and watching it advance towards the tip makes the progress visible.
References
- NHS. Fungal nail infection. nhs.uk
- NHS. Athlete's foot. nhs.uk
- National Institute for Health and Care Excellence. Clinical Knowledge Summary: Fungal nail infection. cks.nice.org.uk
- DermNet. Fungal nail infections. dermnetnz.org
- National Institute for Health and Care Excellence. Suspected cancer: recognition and referral (NG12). nice.org.uk
Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. An abnormal nail is not always a fungal infection, and a new dark streak in a nail should always be assessed. Always consult a qualified healthcare professional for diagnosis and treatment. In a medical emergency, call 999.