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We review published data on rates of oral antifungal resistance among\n                    <jats:italic>Trichophyton<\/jats:italic>\n                    species; causes of antifungal resistance and methods to counteract it; and in\u00a0vitro data on the role of topical antifungals in the treatment of onychomycosis. Antifungal resistance among species of\n                    <jats:italic>Trichophyton<\/jats:italic>\n                    against terbinafine and itraconazole\u2014the two most common oral treatments for onychomycosis and other superficial fungal infections caused by dermatophytes\u2014has been detected around the globe. Fungal adaptations, patient characteristics (e.g., immunocompromised status; drug\u2013drug interactions), and empirical diagnostic and treatment patterns may contribute to reduced antifungal efficacy and the development of antifungal resistance. Antifungal stewardship efforts aim to ensure proper antifungal use to limit antifungal resistance and improve clinical outcomes. In the treatment of onychomycosis, critical aspects of antifungal stewardship include proper identification of the fungal infection prior to initiation of treatment and improvements in physician and patient education. Topical ciclopirox, efinaconazole and tavaborole, delivered either alone or in combination with oral antifungals, have demonstrated efficacy in\u00a0vitro against susceptible and\/or resistant isolates of\n                    <jats:italic>Trichophyton<\/jats:italic>\n                    species, with low potential for development of antifungal resistance. Additional real\u2010world long\u2010term data are needed to monitor global rates of antifungal resistance and assess the efficacy of oral and topical antifungals, alone or in combination, in counteracting antifungal resistance in the treatment of onychomycosis.\n                  <\/jats:p>","DOI":"10.1111\/myc.13683","type":"journal-article","created":{"date-parts":[[2024,1,3]],"date-time":"2024-01-03T21:55:03Z","timestamp":1704318903000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":43,"title":["Treatment of onychomycosis in an era of antifungal resistance: Role for antifungal stewardship and topical antifungal agents"],"prefix":"10.1111","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8664-7723","authenticated-orcid":false,"given":"Aditya K.","family":"Gupta","sequence":"first","affiliation":[{"name":"Mediprobe Research Inc.  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