Laser treatment for toenail fungus: Does it work?

Some people with toenail fungus find that some available treatments may come with unappealing tradeoffs. Over-the-counter antifungal topical medications are commonly used to treat toenail fungus, but these medications can be messy and are often ineffective because they don’t penetrate the nail plate. Oral antifungal medications are effective, but they may pose side effects for some people. In recent years, an alternative, drug-free toenail fungus treatment has become an option for some people—laser therapy.

Solid state lasers provide continuous or fast-pulsing beams of light that penetrate the toenail, where the fungus exists. Lasers treatments have been used for toenail fungus with minimal risk of side effects. While laser therapy has shown promise as a treatment, results from studies have been inconsistent.

Toenail fungus can return after laser treatment. Recurrence of toenail fungus is relatively common even after oral antifungal treatment, and studies have reported that anywhere from 10% to 50% of people see the fungus return over time after it has cleared. Researchers point out that more studies are needed to determine the long-term effectiveness of laser treatment for nail fungus and to identify the most effective devices for the various types of fungal infections.

Several laser systems have been approved by the FDA for “temporary increase in clear nail”. None has been approved as a fungicidal treatment since studies are lacking and more clinical evidence is needed to prove effectiveness.

Laser therapy for toenail fungus takes place in a clinical setting. The affected nails may be cleaned with alcohol and trimmed. The laser is focused on the toenail for a certain amount of time, based on the type of laser and severity of the infection.

The number of treatment sessions you might need depends on the severity of the infection and the type of laser used. Many studies indicate that most patients need multiple treatments, with four to eight weeks between sessions.

It can take anywhere from three months to over a year for a laser-treated toenail fungus to improve, and toenail fungus may return.

Although laser therapy for toenail fungus isn’t painful for most people, some report warmth or tingling sensations, which can be uncomfortable. There are typically minimal side effects after the treatment.

Talk to your healthcare provider to determine whether laser therapy might be appropriate for you. Although toenail fungus isn’t generally dangerous or painful for healthy people, it can spread to other toenails—and other people. Treating toenail fungus can prevent it from worsening or spreading.

Updated by Julie McDaniel, MSN, RN, CRNI, October 2024.

Sources:

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5770012/
2. https://www.uptodate.com/contents/onychomycosis-management
3. https://www.aad.org/public/diseases/a-z/nail-fungus-treatment
4. https://www.aafp.org/pubs/afp/issues/2013/1201/p762.html
5. https://www.fda.gov/files/medical%20devices/published/Medical-Devices-and-Clinical-Trial-Design-for-the-Treatment-or-Improvement-in-the-Appearance-of-Fungally-Infected-Nails---Guidance-for-Industry-and-Food-and-Drug-Administration-Staff.pdf