Reviewed by Evan Lewis, PhD. Last updated August 2026.
Laser treatment for toenail fungus clears the fungus from lab tests in roughly 7 of 10 patients, but a 2019 review of 22 trials found only 7.2% ended up with a fully clear, normal-looking nail. So laser usually does something. It just rarely finishes the job on its own.
The gap between the first two bars and the third is the whole story of laser.
What does a laser actually do to the fungus?
It cooks it. A 1064-nm Nd:YAG or a CO2 laser fires pulses of light through the nail plate, and the fungus underneath absorbs that energy as heat. Fungal cells handle heat worse than your nail bed does, so the idea is to push the temperature high enough to damage them and stop short of burning you.
That is why the nail plate stops mattering. Creams have to soak through a dense keratin lid to reach the problem. Light goes straight through it.
Nice idea. The trouble starts when you ask what happens next.
So does laser work for toenail fungus?
It depends entirely on which finish line you use.
Yeung and colleagues pooled 22 prospective laser trials covering 755 patients and reported three separate numbers. Mycological cure, meaning the lab could no longer grow fungus from the nail, hit 70.4% (95% CI 52.2 to 83.8). Clinical improvement, meaning the nail looked better, hit 67.2%. Complete cure, meaning a clear nail and a clean lab result, came in at 7.2%, with a confidence interval running from 1.9% all the way to 23.5%.
A second review the same year, Ma and colleagues across 35 articles, 1,723 patients and 4,278 nails, landed on a 63.0% mycological cure rate. Close enough to the first review that the lab-result finding looks real.
Then there is the strictest read of all. The 2020 Cochrane review of toenail fungus treatments looked at the 1064-nm Nd:YAG laser and concluded there may be little or no difference in mycological cure at 52 weeks. Cochrane also flagged the real problem with this field. 80% of the studies they found were about topical products. Devices barely got studied at all.
Is laser FDA approved for nail fungus?
Not for the infection. The American Academy of Dermatology states that the FDA has approved laser treatment to improve the look of a nail after the fungal infection has cleared, and has not approved any laser to treat the infection.
Read that twice, because most clinic websites do not. The clearance is cosmetic. It is about appearance after the fact.
Insurers have drawn the same line. BlueCross BlueShield of South Carolina calls laser treatment of onychomycosis investigational and not medically necessary, on the grounds that published evidence does not yet show it improves health outcomes. That is why you pay cash. For real Canadian clinic quotes, we broke those down separately in what laser toenail treatment costs in Canada.
Do at-home nail fungus laser devices work?
Nobody can tell you, and that is the honest answer. Every trial above used a clinic machine, a 1064-nm Nd:YAG or a CO2 laser, operated by someone trained to stop before the toe burns. The handheld units sold online run at a fraction of that output, for obvious safety reasons, and none of them were what those 22 studies measured.
So when a product listing quotes a 70% figure, check whose device produced it. The number is almost always borrowed from the clinic literature and reprinted next to a gadget that has never been through a trial of its own. Buy one if you want, but buy it knowing that.
Why does the nail still look bad after the fungus is gone?
Because the damaged nail does not repair. It has to grow out and get replaced, and toenails are slow.
Yaemsiri and colleagues measured healthy young adults and found toenails grow 1.62mm per month against 3.47mm for fingernails. A big toenail runs 15 to 20mm from cuticle to tip. Do that division and you get most of a year before the last damaged millimetre reaches the clippers.
This is the single biggest reason people think a treatment failed at week six. The lab result changed. The photo has not caught up yet.
How does laser compare to the other options?
Here is every route side by side, using the strongest published number we could find for each and linking the source so you can check it.
| Option | Time and effort | Best published result | Trade-off |
|---|---|---|---|
| Laser | 1 to 3 clinic visits, 30 to 60 min each | 7.2% complete cure, 70.4% lab cure (Yeung 2019) | Cash only. Evidence base is thin and inconsistent. |
| Oral terbinafine | Daily pill, 12 to 16 weeks | 23% complete cure on the big toenail, 51% to 67% on smaller toes (Shemer 2015) | Systemic drug. Needs a prescription and liver awareness. |
| Prescription topical (efinaconazole) | Brush on daily for 48 weeks | 17.8% and 15.2% complete cure across two trials (Elewski 2013) | Expensive, and a full year of not missing a day. |
| Daily aqueous iodine routine | Soak 5 to 7 min, 3 to 4 times a week, spray daily | Cosmetic care. Iodine itself has a long published record as an ingredient. | You have to actually keep doing it. No clinic visit, no prescription. |
Notice what the table does to the usual sales pitch. The oral pill has the highest complete cure number in the row, and it still only reaches 23% on the big toe, which is the toe almost everybody is actually worried about. That figure comes from Shemer and colleagues, who tracked terbinafine across every affected toenail rather than the big toe alone and found the small toes cleared two to three times more often.
The prescription topical numbers, 17.8% and 15.2%, come from the two phase III efinaconazole trials published in JAAD in 2013. Cochrane rated the evidence behind that one as high quality, which is more than laser can say, and it still leaves 8 in 10 people short of a clear nail.
Nobody is winning here. That is the honest picture.
Do any nail fungus treatments work?
Yes and no, and the split is worth being clear about. Every route in the table above moves the lab result for most people. None of them reliably hands back a clear nail. The best complete-cure figure in the whole table is 23% on the big toenail, and that comes from a pill you need a prescription and a liver conversation for.
What separates the people who get somewhere from the people who give up is rarely which bottle they picked. It is whether they kept going through the months when nothing visible was happening, and whether they dealt with the shoes and the shared floor at the same time. A nail that is reinfected in month four looks identical to a nail that never responded at all.
Do Fungi Nail, Kerasal, Lamisil or Lotrimin work on toenail fungus?
Start with the back of the box, because it settles most of this before you spend anything. The FDA-registered DailyMed labels for Lamisil AT, Lotrimin AF spray and Lotrimin Ultra all say the same thing: not for use on the nails. They are cleared for skin, for athlete's foot and ringworm. Lotrimin is also three different active ingredients depending on which box you pick up, so the name on the front tells you less than the ingredient line on the back.
Fungi Nail is undecylenic acid, and Kerasal Nail Renewal is sold on how the nail looks and feels rather than as a prescription drug, so the two are answering different questions from each other. We put the undecylenic acid case beside iodine in undecylenic acid versus iodine on a toenail. Whichever aisle you shop in, the nail still grows at 1.62mm a month, so judge any of them at month six rather than week three.
Who is laser a reasonable fit for?
Laser makes the most sense if you cannot take an oral antifungal because of your liver, your kidneys or another medication, you have the cash, and you go in expecting the fungal load to drop rather than expecting a new nail. If your podiatrist debrides the nail down first, you are also giving the light less keratin to fight through.
It is a poor fit if you are hoping for a one-and-done fix, if the nail is thick and lifted across the whole plate, or if you are going to skip the daily upkeep afterwards and walk back into the same gym shower. Reinfection is what undoes most of these treatments, not the treatment itself.
What we see across our partner clinics
More than 200 foot care clinics in Canada and the US keep IodinePure on the shelf, and a fair few of them own a laser too. The pattern is consistent. The ones with machines still send patients home with something to do between visits, because the visit is a few appointments and the nail takes ten months.
That home half is what the EZ Clear Nails Starter Kit covers. Two ingredients, iodine and water. No alcohol, so it does not sting, and it does not stain your skin or your socks the way a tincture does. You soak your toes for 5 to 7 minutes with 10 to 15ml per tray section, three or four times a week, let them air dry, then spray twice daily in between. It is listed with Health Canada as a cosmetic and it supports the look of clearer nails.
Take a photo of the nail every two weeks. It is the only way you will see change on a 1.62mm-a-month clock.
Common questions
Does laser treatment for toenail fungus actually work?
Partly. Pooled across 22 trials in 755 patients, 70.4% had no growable fungus afterwards and 67.2% said the nail looked better, but only 7.2% reached a fully clear nail with a clean lab result. Laser reliably knocks the fungus back. It rarely delivers a new-looking nail by itself.
How many laser sessions will I need for toenail fungus?
Most clinics run one to three sessions, each 30 to 60 minutes, spaced a few weeks apart. Severe or thickened nails often take more. Whatever the number, you will not judge the result at the last session, because the nail needs another six to twelve months to grow out.
Does insurance cover laser for toenail fungus?
Generally no. BlueCross BlueShield of South Carolina classifies laser treatment of onychomycosis as investigational and not medically necessary, and other insurers use similar language. The reasoning is that published evidence does not yet show improved health outcomes. Expect to pay out of pocket at a private clinic.
Is laser better than taking an antifungal pill?
On complete cure rates, no. Oral terbinafine reached 23% complete cure on the big toenail in one series, against 7.2% pooled for laser. Laser wins on avoiding a systemic drug, which matters if your liver, kidneys or other medications rule the pill out. Ask your prescriber which applies to you.
Does laser for nail fungus hurt?
Most people describe warmth and small hot pinpricks rather than pain, and no anaesthetic is used. Reviews note occasional pain and, rarely, minor bleeding afterwards. There is no recovery time, so you put your shoes back on and leave. Thick nails tend to feel hotter than thin ones.
Why is my nail still yellow after the fungus is gone?
The discoloured part is dead keratin and it cannot heal. It has to grow off the end of your toe. Toenails grow about 1.62mm a month, so a 15 to 20mm big toenail needs the better part of a year to replace itself completely.
How long does laser toenail fungus treatment take?
Each appointment runs 30 to 60 minutes, and a course of one to three sessions is usually spread over a few weeks, so the clinic part is often finished inside two months. The nail runs on a much slower clock than the appointment book, and most people are looking at the better part of a year before the regrown section reaches the tip.
How long does fungal nail treatment take to work?
The lab result can turn around in a few months. The look of the nail cannot, because damaged keratin does not repair and has to grow off the end of the toe. Toenails move about 1.62mm a month and a big toenail is 15 to 20mm long, so plan on nine to twelve months before the last damaged section reaches the clippers.
Does Jublia work on toenail fungus?
In its two phase III trials, efinaconazole reached mycologic cure of 55.2% and 53.4% at 52 weeks, while complete cure, meaning a clear nail as well as a clean lab result, was 17.8% and 15.2%. CADTH's review of it notes that a mycologic cure rate alone may overestimate the treatment effect. It is a brush-on you apply every day for a full year.
Can you get toenail fungus from work boots?
Work boots are one of the classic setups for it. StatPearls notes that wearing occlusive shoes for extended periods predisposes people to dermatophyte infections, and that the risk rises with excessive sweating. A safety boot worn ten hours a day gives you both at once. Two pairs on rotation so each one dries fully, and a sock change at lunch, do more than most people expect.
The bottom line
Laser is a real tool with a small honest win rate. If a clinic quotes you a course and promises a clear nail, the published record does not support that promise, and the FDA clearance behind the device is about appearance after clearing rather than about the infection.
Whatever route you take, the daily part is the part you control. Keep the nail short and thin, dry your feet properly, treat your shoes as part of the problem, and give it the full ten months.
Next reads
- What laser toenail treatment actually costs in Canada
- Chiropodist or podiatrist, and which one to book
- Eight home remedies for nail fungus, and what the evidence says
- How aqueous iodine and Jublia compare
- Yellow, thick or brittle toenails and what is behind them
Evan Lewis, PhD, specializes in natural and nutritional therapies for the prevention and management of chronic diseases and their complications. His research spans chronic disease, diabetes complications, clinical nutrition and nerve health, including topical iodine approaches for foot care and wound health.
Sources: Yeung K et al., Lasers in Medical Science, 2019 (PMID 31254131); Ma W et al., Medicine (Baltimore), 2019 (PMID 31770202); Foley K et al., Cochrane Database of Systematic Reviews, 2020 (PMID 31978269); Shemer A et al., JEADV, 2015 (PMID 25079781); Elewski BE et al., Journal of the American Academy of Dermatology, 2013 (PMID 23177180); Yaemsiri S et al., JEADV, 2010 (PMID 19744178); CADTH Common Drug Review, efinaconazole, NCBI Bookshelf NBK543976; StatPearls, Tinea Pedis, NCBI Bookshelf NBK470421; DailyMed labels for Lamisil AT, Lotrimin AF and Lotrimin Ultra; American Academy of Dermatology; BlueCross BlueShield of South Carolina medical policy. IodinePure products are listed with Health Canada as cosmetics. This article is educational and is not medical advice.
