Strategies and Novel Therapies for the Treatment of Recalcitrant Dermatophytosis

Background: Dermatophytosis remains a leading superficial fungal infection worldwide, but chronic, recurrent, and resistant cases have risen sharply over the past decade. Increasing antifungal resistance, misuse of steroid–antifungal combinations, and host factors such as immunosuppression contribute to poor therapeutic outcomes. Traditional agents like terbinafine and itraconazole are losing efficacy in several endemic regions, necessitating optimized regimens exploring the novel therapies. Recent advances include super-bioavailable itraconazole, newer triazoles, and non-azole antifungals with improved pharmacokinetics. This review assesses current treatment strategies, highlights emerging options aimed at improving efficacy, lowering relapse rates, and informing future research directions. Conclusion: While terbinafine and itraconazole remain first-line choices, The resistant cases require extended courses, combination therapy, or innovative delivery methods. The Adjunctive approaches—photodynamic therapy, chemical peels, topical amphotericin B and host-targeted strategies show promise. Continued progress depends on antifungal stewardship, standardized treatment protocols, and rigorous clinical trials to secure durable disease control and improved patient outcomes.