Yes — in most cases, fungal nails should be treated. Onychomycosis is not just a cosmetic problem. If left untreated, it can gradually worsen, spread to other nails or surrounding skin, and in some people lead to complications such as pain, recurrent infection, or cellulitis. This is especially important for people with diabetes or poorer circulation.
Why Treatment Matters
- It usually does not clear on its own. The infection often slowly progresses and can damage the nail further over time.
- It can act as a source of reinfection. Fungal nails may continually spread fungus to the skin or other nails, including athlete’s foot.
- It may increase the risk of secondary infection. Thickened, damaged nails can make the surrounding skin more vulnerable, particularly in high-risk patients.
- It can cause problems for people with diabetes. Fungal nail infection is associated with a higher risk of foot complications, including ulcers.
- It can affect comfort and confidence. Some people develop pain, shoe pressure, mobility issues, or distress about the appearance of the nail.
Treatment Options
Oral antifungals such as terbinafine or itraconazole: Treat the infection from inside the body. Around 6–12 weeks for toenails, 3–6 weeks for fingernails. Best for moderate to severe infections or multiple affected nails.
Topical treatments such as ciclopirox or amorolfine: Applied directly to the nail. Usually 6–12 months. Best for mild to moderate cases.
Nail debridement: The nail is thinned and reduced to remove infected tissue. Ongoing as needed. Best for pain relief and support alongside other treatments.
Laser treatment: Uses light energy aimed at the fungal infection. Often several sessions. Best for people who wish to avoid oral medication.
Nail removal: The nail is removed chemically or surgically. Usually one-off. Best for severe or resistant cases.
Oral terbinafine is generally considered the most effective treatment option, but it may require liver monitoring. Topical treatments are safer and easier to use, but they usually take longer and have lower cure rates.
When Treatment Is Especially Important
Treatment should be prioritised if the person has:
- Diabetes, poor circulation, or immunosuppression
- Pain or discomfort when wearing shoes
- Repeated athlete’s foot
- A nail that is thick, crumbly, or spreading
- Concern or embarrassment about the appearance
When Monitoring May Be Reasonable
In a healthy person with a very mild, painless infection limited to the edge of the nail, monitoring may sometimes be an option. Even then, fungal nail infection often progresses over time, so treatment is usually the better long-term choice.
So, should fungal nails be treated?
Usually, yes. They rarely clear by themselves and often get worse gradually. Over time, they can become thicker, more uncomfortable, and more difficult to manage.
The main treatment options are:
- Tablets, which tend to work best but may need monitoring.
- Topical treatments, which are safer but slower.
- Nail thinning, which helps reduce pressure and improve treatment results.
- Laser treatment, which may suit some people who cannot take tablets.
- Nail removal, which is generally reserved for severe cases.
If you have diabetes, pain, or signs that the infection is spreading, it is best not to delay treatment.
For professional fungal nail treatment in Maida Vale, London, visit Deseree Myburgh FHP — qualified Foot Health Practitioner offering clinic and home visits. Book at dessiefhp.com.
