Taking an oral antifungal medication, such as terbinafine, can be effective for clearing a fungal toenail infection. However, when the fungal infection has caused the toenail to lift away from the nail bed or become significantly thickened, distorted, or misshapen, medication alone may not always be enough to restore the nail to its normal shape.
In these cases, the oral antifungal may help a new, clear nail grow, but the existing nail plate may already be too distorted to return to its natural curvature and attachment. For this reason, removing the affected toenail can sometimes be the better treatment option.
By removing the infected nail, the oral antifungal treatment can target the remaining soft tissue infection rather than having to treat an active fungal infection within the thickened nail plate itself. This may allow the medication to be taken for a shorter period, often around two to six weeks, rather than the usual three to six months required when the infected nail remains in place.
The tablet may be started a few days before the toenail removal procedure and continued afterwards as advised. This approach may reduce the length of time the liver is exposed to the medication while still helping to clear the fungal infection effectively.
Once the infected nail has been removed, the new nail has a better chance of growing back properly attached to the nail bed and with a more normal shape. However, if the fungal infection has been present for many years, there may be some long-term damage or scarring to the nail bed. For example, a toenail that has been infected and distorted for 20 or 30 years may have caused chronic irritation and changes beneath the nail, meaning the nail bed may not fully return to its original healthy structure.
The sooner a fungal toenail infection is treated properly, the better the chance of preserving the nail bed and allowing a healthier nail to grow in the future.
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