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Chemical Avulsion of Fungal Toenails with 40% Urea Paste

Thickened, crumbly toenails caused by fungal infections (onychomycosis) can be very difficult to treat, particularly when the infection is longstanding and affects multiple nails.

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Typically, the nail becomes thickened and unsightly, can be uncomfortable in shoes, and hard to cut at home. While antifungal tablets and/or topical treatments are effective, they don’t always work for everyone*, and the former has a bad press (we'll discuss this at a later date). *this will be the subject of another blog post, too much to cover here!

One gentle and effective alternative is chemical avulsion – the removal ('avulsion') of the infected nail using a strong softening cream (the 'chemical' - urea) as opposed to surgical avulsion (nail removal under anaesthetic).

What is Chemical Avulsion?

Chemical avulsion involves applying a 40% urea paste to the affected toenail under occlusion. Urea is a substance that softens keratin (the protein that makes up nails and skin). At this concentration, it dissolves the keratin to break down the nail plate gradually without damaging the nail bed or the surrounding skin.

Over a series of applications, typically over 1-2 weeks, the infected nail is softened and painlessly lifted away.

How Does the Treatment Work?

  1. Application of paste – A 40% urea paste is carefully applied to the surface of the nail and covered with a protective (occlusive) dressing.

  2. Repeated daily (or every couple of days, if able to keep the plaster in place) - the process is repeated after showering (which also helps to soften the nail plate)

  3. Gradual removal – Over a couple of weeks, the diseased nail plate is sufficiently softened that it can be gently removed/pared away without the need for local anaesthetic or surgical instruments.

Benefits of 40% Urea Paste (or Cream)

  • Painless – No needles, no surgery.

  • Safe – The surrounding skin is unaffected if properly applied.

  • Gentle – The nail is removed gradually, reducing the risk of complications.

  • Effective – Once the diseased nail is gone, antifungal treatments can be applied directly to the nail bed, so that new growing nail is not infected with fungus

  • Convenient – Suitable for people who may not be able to have surgical nail removal, or who cannot take oral antifungals (such as those with certain medical conditions), or do not wish to take it.


    Canespro Fungal Nail Ointment for the Chemical Avulsion of Infected Toenails
    Canespro Fungal Nail Ointment for the Chemical Avulsion of Infected Toenails

    Canespro fungal nail ointment is a treatment specifically marketed for this purpose. The paste is thicker than a 40 or 50% urea cream, so it is easier to keep in place. However, at around £30 per tube, it is also a more expensive option. Furthermore, despite the name, this product does not contain an antifungal.


After the Nail is Removed


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Once the infected nail is gone, the treatment protocol is as follows: -


  1. Application of a topical antifungal treatment to prevent the fungus from returning.

  2. Adopting good foot hygiene – i.e. drying feet thoroughly after bathing, not lingering in sweaty socks and shoes, wearing flip-flops in communal changing rooms, treating spores in socks and footwear, and regularly applying moisturiser to bolster the skin's natural defences against infection.

  3. Regular monitoring – ensuring the new nail grows back without a fungal infection.


    Is It Right for Everyone?


Chemical avulsion is particularly useful for people who: -

- Have thickened fungal nails that are difficult to cut or file down at home

- Prefer to avoid surgical nail removal.

- Are not suitable for, or would prefer an alternative, to oral antifungal medication.

Chemical nail avulsion will most likely be ineffective and is not indicated if the nail is only mildly infected and if you have any concurrent health conditions (such as diabetes or circulatory problems) you should follow this treatment only under the guidance of an HCPC-registered podiatrist.


✅ In summary: Chemical avulsion with 40% urea paste is a safe, painless, and effective way of removing fungal toenails without surgery. It is important to note that this is not a standalone treatment, and an antifungal agent MUST be applied to the nail bed in order to treat the fungal infection successfully.


Do you want advice on whether this treatment is appropriate for you? You can book an appointment with Felicity here (if you live in Oxfordshire), otherwise virtual consultations are also available and can be booked here.

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