Caleb Foster
Toenail fungus, medically known as onychomycosis, is a common condition that can affect anyone and is challenging to cure. Treatment options include oral medications, topical treatments, and laser therapy. In severe cases, toenail removal may be recommended, but this is typically a last resort. When creating a treatment plan, doctors consider various factors, including the patient's health, the severity of the infection, and the type of fungus. While home remedies and over-the-counter treatments are available, they are generally less effective than prescription medications. This raises the question: should the old nail be removed during toenail fungus treatment?
| Characteristics | Values |
|---|---|
| Treatment goals | Get rid of the fungus and restore the nail |
| Treatment options | Oral medications, antifungal nail medicine, laser treatment, toenail removal, natural remedies |
| Toenail removal procedure | Loosening the skin around the nail, then removing the nail from the toe |
| Toenail removal necessity | Badly infected nails sometimes need to be removed |
| Toenail removal follow-up | Antifungal therapy to prevent the fungus from returning |
| Natural remedies | Soaking feet in apple cider vinegar or Listerine, applying VapoRub to the nail, tea tree oil |
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Oral medication
Terbinafine is a common oral medication for toenail fungus, available as 250mg tablets or granules. For adults, the typical dosage is once a day for 12 weeks, although visible results may take up to 9 to 12 months. It is important to follow the doctor's instructions and take the medication consistently, even if symptoms improve, to ensure the infection is completely cleared. Elderly patients, in particular, should exercise caution due to potential liver, kidney, or heart problems.
Itraconazole is another oral antifungal medication, typically taken once a day for 6 to 12 weeks. While it may have fewer side effects than terbinafine, it can interact negatively with other medications, so doctor supervision is necessary.
Posaconazole, available as a pill or liquid suspension, is a newer medication typically used for serious fungal infections but can be prescribed off-label for toenail fungus. While effective, there are more affordable and accessible options available.
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Antifungal creams
While treating nail fungus, the goals of treatment are to get rid of the fungus and restore the nail. A podiatrist or dermatologist will tailor the treatment to the patient's needs, taking into account their health, other medical conditions, medications, the extent of nail damage, and the type of fungus.
Clotrimazole is a broad-spectrum antifungal that is often used in over-the-counter creams to stop fungal growth. It is proven to be effective, especially on the skin, like the soles, between the toes, or around the nail, rather than directly on the nail plate itself. Tea tree oil, derived from the Australian tea tree plant, has also been used in creams with effectiveness comparable to clotrimazole.
For more severe cases, a doctor may prescribe an antifungal medicine that you paint on your nails, such as ciclopirox. This will look like a clear nail polish and will contain an antifungal drug. You will typically paint it on the affected toenail once a day, allowing it to dry before putting on socks or shoes. Tavaborole is another prescription medication applied daily for up to 48 weeks to treat nail fungus.
While antifungal creams can be effective, oral antifungal pills like itraconazole (Sporanox) and terbinafine (Lamisil) tend to work better for more severe infections. These pills have high success rates but come with potential side effects and drug interactions that require medical monitoring.
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Laser treatment
How it Works
The laser device emits light, which penetrates the nail bed and destroys the fungus without damaging the surrounding tissue. Some experts believe that the light is absorbed by the fungus, causing damage or death to the fungal cells. This process is known as selective photothermolysis, which restricts the growth of the fungus.
Effectiveness and Safety
The effectiveness of laser treatment for nail fungus has been the subject of ongoing research. While some studies have shown promising results, with success rates of around 63%, others have noted a lack of research on its safety and effectiveness. The American Academy of Dermatology (AAD) and the American Academy of Dermatology Association (AADA) both assert that more research is needed to establish laser treatment as a standard option. However, laser treatment may offer a more suitable alternative to medication due to the risk of side effects associated with oral antifungals, such as liver damage and gastrointestinal issues.
Cost
The cost of laser treatment can vary depending on several factors, including the severity of the infection, the number of nails treated, the technology used, and the location of the clinic. On average, it can range from $200 to $700 per session, with more severe cases requiring additional sessions. It is considered a cosmetic procedure and is typically not covered by insurance. However, clinics may offer financing options or payment plans to make it more accessible.
Aftercare
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Toenail removal
Toenail fungus, or onychomycosis, is a common condition that can affect anyone, causing the nail to become thick, discoloured, brittle, and crumbly. While some people may consider it a mere cosmetic concern, it can also lead to pain, swelling, and other discomforts. Therefore, it is essential to address the issue and explore treatment options.
One approach to treating toenail fungus is to remove the affected nail. This procedure is typically carried out under local anaesthesia to numb the area. It is considered a small and straightforward process, but it is not frequently performed. Following the nail removal, antifungal therapy is necessary to prevent the fungus from returning as the nail regrows. This typically involves applying topical treatments or oral medications to eliminate the fungus and restore the nail.
Before performing the procedure, a doctor or podiatrist will consider various factors, including the patient's health, existing medical conditions, medications, the extent of nail involvement, and the type of fungus. In some cases, they may take a nail sample for laboratory analysis to confirm the presence and type of fungus. Additionally, blood tests may be required to assess liver function, especially if certain oral antifungal medications are prescribed, as these can affect the liver.
It is worth noting that toenail removal may not be the first line of treatment. Often, trimming and filing the nail are recommended to facilitate the penetration of topical treatments. Over-the-counter and prescription antifungal creams, gels, sprays, and patches are available and can be effective for mild toenail fungus. Oral antifungal medications, such as itraconazole and terbinafine, are also options, but they usually require longer treatment durations and careful monitoring due to potential side effects and interactions with other medications.
In conclusion, toenail removal is an option for treating severe or persistent toenail fungus. However, it is generally accompanied by antifungal therapy to ensure the fungus does not return. It is important to consult with a healthcare professional to determine the most suitable treatment plan, as individual circumstances and the severity of the condition will influence the recommended approach.
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Home remedies
While medical treatments are the only known methods to effectively treat nail fungus, home remedies may help clear up symptoms. Before trying any at-home remedies, consult a doctor or podiatrist to create a treatment plan that works for you.
It is important to note that you shouldn't use home remedies for toenail fungus if you have diabetes or a weakened immune system. Contact your doctor for the appropriate course of action.
- Tea tree oil has natural antifungal and antiseptic properties. Mix a few drops of tea tree oil with a carrier oil (e.g. coconut or olive oil). Apply directly to the affected nail using a cotton swab. Repeat twice daily for several weeks.
- Apple cider vinegar is a natural remedy that offers an effective, low-cost solution for mild infections.
- Garlic also offers an effective, low-cost solution for mild infections.
- Vicks VapoRub is a topical ointment. Its active ingredients (camphor and eucalyptus oil) may help treat toenail fungus. Apply a small amount of Vicks VapoRub to the affected area at least once a day.
- Snakeroot (Ageratina pichinchensis) extract is an antifungal made from plants in the sunflower family.
In addition to these home remedies, there are also some practical tips to prevent toenail fungus:
- Practice good foot hygiene: Wash and dry your feet daily, especially between the toes.
- Choose breathable footwear: Opt for shoes made of materials that allow airflow.
- Change socks regularly: Avoid wearing damp socks for extended periods.
- Use antifungal powder: Sprinkle antifungal powder in shoes to reduce moisture.
- Avoid walking barefoot in public areas: Use flip-flops in locker rooms and around pools.
- Trim nails properly: Cut nails straight across to avoid ingrown nails, which can harbour fungi.
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Frequently asked questions
Removing the nail allows the product to penetrate deeper into the nail bed. It also helps to prevent the fungus from returning as a new nail grows.
If the infection is deep and has been there for a while, your doctor may recommend removing all or part of the nail.
If the nail is not removed, the fungus may return as the new nail grows.
There are various alternatives to nail removal, including antifungal pills, creams, gels, and laser treatments. Your doctor will determine the best course of treatment based on your individual needs.
