Toenail fungus is notoriously difficult to treat, and most standard treatments are only mildly effective and have high rates of recurrence. You might be wondering -- what's the deal? Why is nail fungus so hard to treat? Here are a few reasons:
The anatomy of the toenail doesn't help in treating nail fungus, and there are a few reasons for that. The first is that dermatophytes, which cause nail fungus, feed on a protein called keratin -- which happens to be exactly what nails are made out of. Fungi are able to embed directly in the nail as they feed on the keratin, which means that even when you are successful in treating the infection, it's still necessary for the infected part of the nail to grow out before it can be fully rid of the fungus. Unfortunately, toenails take their time to grow out.
The second reason is the design of the nail. Nails are similar to claws on other animals in that they're used primarily for mobility. When we walk or run, the soft part of the toes compress and are fortified by the nail as we make strides, providing better traction on the ground. Nails therefore need to be sturdy and durable, and protect the toe against considerable impact. In general, this is a great feature of our nails, but it can cut both ways. On one side, toenails are very durable, and are built almost like their own fortress against outside threats. On the other, if that fortress is penetrated by an infection, the design of the nail makes it difficult for medicine to fully access all parts of the infection, allowing fungi the opportunity to dig in for the long hall.
Another difficulty is that dermatophytes are pretty darn resilient. They can live for weeks, even months, on surfaces and are quick to pounce at opportunities to spread. They prefer damp, dark places the most, and can live without any kind of sunlight, making shoes and socks prime locations to hide out. As mentioned above, they feed on keratin, which, unfortunately is exactly what nails are made of, so when they're able to infect a nail, they're not too eager to leave.
Poor Treatment Options
A big reason nail fungus is difficult to treat is a lack of effective treatment choices. Between drugs that bring long term health risk and an abundance of low quality, ineffective topical brands, there are few products that safely do the job.
Risky Oral Antifungals
Oral antifungal drugs are an oft used treatment for nail fungus, but can come with serious side effects. Among other risks, oral antifungals have been seen to affect kidney and liver function, cause liver damage leading to liver failure, weaken heart contractions, and have a range of unfavorable effects when mixed with other common medicines. Risk factors are a significant deterrent for many patients considering oral antifungals.
Ineffective Topical Concoctions
There are plenty of topical ointments and alternative therapies out in the market, but many seem to have been concocted in back-room cauldrons and boast ingredient lists longer than some novels. Most of these are ineffective and leave people frustrated at the lack of progress in fighting their nail fungus.
Natural ingredients have been shown to be safe and effective against nail fungus, but many manufacturers opt for cheaper production costs that result in either harsh, unhealthy chemicals, or diluted formulas. Similar to the risks of oral antifungals, check the ingredients of topical antifungals, and don't gamble with your long term health when treating nail fungus.
Expensive Laser Treatment
Some patients consider laser treatment for fungal toenails, but it comes at a cost -- often upwards of $1000, and isn't covered by most insurance. For that reason, laser is generally used more in extreme cases and is not a reasonable option for most fungal nail infections.
There are also questions on how effective these treatments are in the long term. Few reputable trials have been conducted on the benefits and risks of laser treatment to date, and even those with FDA approval come with the caveat that they're approved for "temporarily" treating cases of nail fungus.
As you can see, there are a lot of reasons nail fungus is difficult to treat -- from the anatomy of the toenail and resiliency of the fungus to risky and ineffective treatment options in the market. Toenail fungus can vary significantly in severity and symptoms, so decisions on how to treat an infection should be made on a case by case basis. At the end of the day, it takes patience, perseverance, and a strong treatment strategy to ultimately defeat the fungus -- because if one thing's for sure, that fungus is not going to leave without a fight.