Onychomycosis, commonly known as toenail fungus, is a persistent infection of the nail unit that affects a large portion of the population. The discoloration, thickening, and brittleness caused by the fungus often lead to a strong desire for a rapid solution. Many people wonder if simply removing the infected nail will provide a quick and permanent cure. This article examines the nature of the infection, clarifies the limited role of nail removal, and details the professional medical strategies used to eradicate the fungus.
Understanding Onychomycosis
The difficulty in treating toenail fungus lies in the location and structure of the infection. The fungus, most often a type of dermatophyte, does not just live on the surface of the nail plate. Instead, it burrows beneath the nail and establishes itself within the nail bed and the deeper nail matrix where new nail cells are produced.
Toenails are composed of dense, multi-layered keratin. This tough structure creates a physical barrier that prevents most topical medications from penetrating in high enough concentrations to reach the infection deep below. Furthermore, the toes have a naturally limited blood supply. Since systemic medications travel through the bloodstream, this reduced circulation makes it harder for the body to fight the infection from the inside. The slow growth rate of toenails means that even after the fungus is killed, it takes many months for a healthy, uninfected nail to completely replace the damaged one.
Does Removing the Nail Cure the Fungus
Removing the toenail, a procedure medically known as avulsion, is not an effective cure for onychomycosis when done as a standalone treatment. The infection is deeply embedded in the underlying nail bed, not solely contained within the nail plate itself. If the nail bed is not thoroughly treated with antifungal agents simultaneously, the new nail that grows back will almost certainly become reinfected.
Professional avulsion is sometimes performed by a physician, but only to facilitate other treatments. Removing a severely thickened or painful nail allows topical antifungal medications to be applied directly to the exposed nail bed, significantly improving drug penetration. This physical removal is considered an adjunct therapy, meaning it is used in combination with aggressive antifungal medication, not as a replacement for it. Physical removal alone has a very low mycological cure rate, confirming that the underlying fungal reservoir must be chemically or systemically eradicated.
Professional Medical Treatments
The most effective treatments for onychomycosis involve professional medical intervention aimed at eliminating the fungus from the nail bed.
Oral Antifungals
For moderate to severe infections, oral antifungal medications are often the standard approach. Drugs like Terbinafine are taken systemically, allowing the medication to reach the fungus through the bloodstream and achieve high cure rates. Because these medications can affect the liver, patients typically require blood tests to monitor liver function throughout the treatment course.
Topical Solutions
For milder cases or for patients who cannot take oral medication due to health concerns, prescription-strength topical solutions are used. These antifungals, such as lacquers containing ciclopirox, efinaconazole, or tavaborole, are applied directly to the nail. While they have a favorable safety profile, their efficacy is often limited by poor penetration through the dense nail plate unless the nail is significantly thinned first.
Laser Therapy
A third option involves device-based treatments, such as laser therapy. Lasers use focused light energy to generate heat that penetrates the nail plate and disrupts the fungal cells in the nail bed. Laser treatment is often used as an alternative for patients who have contraindications to oral drugs or as a combined therapy with topical agents.
Preventing Fungal Recurrence
After successful treatment, proactive hygiene measures are necessary to prevent the fungus from returning, as recurrence rates can be high. Fungi thrive in warm, moist environments, making proper foot care a continuing requirement.
It is important to wash feet daily and dry them completely, paying particular attention to the spaces between the toes where moisture often lingers. Footwear should be chosen for breathability; shoes made of materials like leather or mesh are preferable to those that trap heat and moisture.
Avoid wearing the same pair of shoes on consecutive days, allowing them at least 24 hours to dry out thoroughly between uses. Antifungal powders or sprays should be applied inside shoes to kill any lingering fungal spores. Additionally, avoid walking barefoot in public damp areas, such as locker rooms and pool decks, and ensure that all nail clippers and tools are sanitized before use.