{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T13:30:50Z","timestamp":1787319050662,"version":"build-2736575974"},"reference-count":56,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Dermatophytosis remains one of the most prevalent superficial fungal infections worldwide and is increasingly encountered as a persistent or difficult-to-treat syndrome. A major clinical problem is that apparent treatment failure is often attributed to antifungal resistance, although many cases are instead driven by diagnostic uncertainty, corticosteroid-modified disease, reinfection, inadequate exposure, poor adherence, and limited drug delivery within keratinized tissues. This narrative review was developed to clarify the distinction between true antifungal resistance and clinical recalcitrance, with particular attention to terbinafine-resistant Trichophyton species, Trichophyton indotineae, tinea incognito, onychomycosis, dermatophytoma, and high-barrier skin and nail infections. We synthesized peer-reviewed literature and guideline-level evidence addressing epidemiology, molecular mechanisms of resistance, clinical phenotypes of recalcitrance, diagnostic escalation, therapeutic decision-making, and antifungal delivery in keratinized tissues. The review contributes a dermatology-centered conceptual framework in which persistent dermatophytosis is interpreted through both microbiological resistance and modifiable recalcitrance drivers. This approach emphasizes confirmation of fungal disease when indicated, phenotypic and anatomic classification, avoidance of inappropriate corticosteroid combinations, optimization of dose, duration, vehicle, and adherence, measures to improve drug access and reduce protected fungal burden in high-barrier disease, and prevention of reinfection from reservoirs. The proposed framework may support more rational antifungal use and reduce unnecessary escalation; however, it is based on narrative synthesis rather than a systematic review or prospective validation. Additional studies are needed to determine how such structured clinical approaches affect clinical outcomes, relapse rates, antifungal exposure, and resistance emergence in real-world dermatology practice.<\/jats:p>","DOI":"10.3390\/antibiotics15070634","type":"journal-article","created":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T05:48:16Z","timestamp":1782366496000},"page":"634","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Resistance and Recalcitrance in Dermatophytosis: Mechanistic and Clinical Considerations for Keratinized Tissues"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-8660-7220","authenticated-orcid":false,"given":"Alfredo","family":"Valdez-Martinez","sequence":"first","affiliation":[{"name":"Secci\u00f3n de Micolog\u00eda, Hospital General \u201cDr. Manuel Gea Gonz\u00e1lez\u201d, Mexico City 14080, Mexico"},{"name":"Cl\u00ednica Hospital 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Polit\u00e9cnico Nacional, Plan de San Luis y D\u00edaz Mir\u00f3n, Mexico City 11340, Mexico"},{"name":"Servicio de Medicina F\u00edsica y Rehabilitaci\u00f3n, Hospital General de Zona No. 197, Texcoco 56108, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando","family":"Bastida-Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Laboratorio de Biolog\u00eda Molecular, Laboratorio Estatal de Salud P\u00fablica del Estado de M\u00e9xico, Toluca de Lerdo 50130, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7298-158X","authenticated-orcid":false,"given":"Erick","family":"Mart\u00ednez-Herrera","sequence":"additional","affiliation":[{"name":"Secci\u00f3n de Estudios de Posgrado e Investigaci\u00f3n, Escuela Superior de Medicina, Instituto Polit\u00e9cnico Nacional, Plan de San Luis y D\u00edaz Mir\u00f3n, Mexico City 11340, Mexico"},{"name":"Fundaci\u00f3n Vithas, Grupo Hospitalario Vithas, 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Int."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1978","DOI":"10.3201\/eid3009.240118","article-title":"Recognition of antifungal-resistant dermatophytosis by infectious diseases specialists, United States","volume":"30","author":"Gold","year":"2024","journal-title":"Emerg. Infect. Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1080\/14787210.2024.2390629","article-title":"Antifungal resistance in dermatophytes\u2014Review of the epidemiology, diagnostic challenges and treatment strategies for managing Trichophyton indotineae infections","volume":"22","author":"Gupta","year":"2024","journal-title":"Expert Rev. Anti-Infect. Ther."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Uhrla\u00df, S., Verma, S.B., Gr\u00e4ser, Y., Rezaei-Matehkolaei, A., Hatami, M., Schaller, M., and Nenoff, P. (2022). Trichophyton indotineae\u2014An emerging pathogen causing recalcitrant dermatophytoses in India and worldwide\u2014A multidimensional perspective. J. Fungi, 8.","DOI":"10.3390\/jof8070757"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"101273","DOI":"10.1016\/j.lanmic.2025.101273","article-title":"Emerging terbinafine-resistant Trichophyton indotineae between 2018 and 2023: A multinational genomic epidemiology study","volume":"7","author":"Rhodes","year":"2026","journal-title":"Lancet Microbe"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1001\/jamadermatol.2024.1125","article-title":"Resistant Trichophyton indotineae dermatophytosis\u2014An emerging pandemic, now in the US","volume":"160","author":"Bui","year":"2024","journal-title":"JAMA Dermatol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"100740","DOI":"10.1016\/j.mmcr.2025.100740","article-title":"Recalcitrant dermatophytosis due to Trichophyton indotineae: A case series from Sarawak, Malaysia","volume":"50","author":"Tan","year":"2025","journal-title":"Med. Mycol. Case Rep."},{"key":"ref_8","first-page":"e0056223","article-title":"Terbinafine-resistant dermatophytes and the presence of Trichophyton indotineae in North America","volume":"61","author":"Mele","year":"2023","journal-title":"J. Clin. Microbiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e00903-23","DOI":"10.1128\/jcm.00903-23","article-title":"Trichophyton indotineae and other terbinafine-resistant dermatophytes in North America","volume":"61","author":"Lockhart","year":"2023","journal-title":"J. Clin. Microbiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"993","DOI":"10.2147\/CCID.S465942","article-title":"Tinea incognito: An overview","volume":"17","author":"Kokandi","year":"2024","journal-title":"Clin. Cosmet. Investig. Dermatol."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Zacharopoulou, A., Tsiogka, A., Tsimpidakis, A., Lamia, A., Koumaki, D., and Gregoriou, S. (2024). Tinea incognito: Challenges in diagnosis and management. J. Clin. Med., 13.","DOI":"10.20944\/preprints202403.1368.v1"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Gupta, A.K., Wang, T., and Cooper, E.A. (2022). Dermatophytomas: Clinical overview and treatment. J. Fungi, 8.","DOI":"10.3390\/jof8070742"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"adv42089","DOI":"10.2340\/actadv.v105.42089","article-title":"Terbinafine-resistant Trichophyton indotineae in Sweden","volume":"105","author":"Mohseni","year":"2025","journal-title":"Acta Derm. Venereol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4103\/idoj.idoj_668_22","article-title":"IADVL SIG Recalcitrant Dermatophytosis Position Statement on super bioavailable itraconazole","volume":"15","author":"Patel","year":"2024","journal-title":"Indian Dermatol. Online J."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Wang, H., Sun, F., Wang, C., Ye, J., Xia, P., Wang, W., and Wu, Y. (2024). A systematic analysis of the global, regional, and national burden of fungal skin diseases from 1990 to 2021. Front. Epidemiol., 4.","DOI":"10.3389\/fepid.2024.1489148"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Li, D., Fan, S., Zhao, H., Song, J., Guo, L., Li, W., Xu, X., and Li, Q. (2025). Worldwide trends and future projections of fungal skin disease burden: A comprehensive analysis from the Global Burden of Diseases Study 2021. Front. Public Health, 13.","DOI":"10.3389\/fpubh.2025.1580221"},{"key":"ref_17","first-page":"e82483","article-title":"Psychosocial and financial impact of dermatophytosis on patients attending a tertiary care centre at Visakhapatnam: A cross-sectional study","volume":"17","author":"Karanam","year":"2025","journal-title":"Cureus"},{"key":"ref_18","first-page":"39","article-title":"Impact of onychomycosis on the quality of life of patients","volume":"9","author":"Debbagh","year":"2023","journal-title":"Curr. Med. Mycol."},{"key":"ref_19","first-page":"359","article-title":"Onychomycosis: Rapid evidence review","volume":"104","author":"Frazier","year":"2021","journal-title":"Am. Fam. Physician"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1111\/myc.13577","article-title":"Onychomycosis associated with diabetic foot syndrome: A systematic review","volume":"66","year":"2023","journal-title":"Mycoses"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2498571","DOI":"10.1080\/22221751.2025.2498571","article-title":"Genomic epidemiology and antifungal resistance of emerging Trichophyton indotineae in China","volume":"14","author":"Xie","year":"2025","journal-title":"Emerg. Microbes Infect."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"278","DOI":"10.25259\/IJDVL_1547_2024","article-title":"Patterns and factors affecting self-medication practices among patients with dermatophytosis in South India\u2014A case-control study","volume":"92","author":"Karunagaran","year":"2026","journal-title":"Indian J. Dermatol. Venereol. Leprol."},{"key":"ref_23","first-page":"e92679","article-title":"Emerging antifungal resistance in dermatophytosis: A clinicomycological study from North India","volume":"17","author":"Lohariwala","year":"2025","journal-title":"Cureus"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e70417","DOI":"10.1111\/jocd.70417","article-title":"Assessing the therapeutic efficacy of photodynamic therapy, fractional CO2 laser and its combination in the treatment of onychomycosis","volume":"24","author":"Abdou","year":"2025","journal-title":"J. Cosmet. Dermatol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e0153524","DOI":"10.1128\/jcm.01535-24","article-title":"Emergence of terbinafine-resistant Trichophyton indotineae in Ontario, Canada, 2014\u20132023","volume":"63","author":"McTaggart","year":"2025","journal-title":"J. Clin. Microbiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"82","DOI":"10.4103\/ijp.ijp_930_20","article-title":"Topical antifungal\u2013corticosteroid fixed-drug combinations: Need for urgent action","volume":"53","author":"Rana","year":"2021","journal-title":"Indian J. Pharmacol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"347","DOI":"10.4103\/idoj.idoj_643_22","article-title":"Management of dermatophytosis: Real-world Indian perspective","volume":"14","author":"Shenoy","year":"2023","journal-title":"Indian Dermatol. Online J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e70151","DOI":"10.1002\/puh2.70151","article-title":"The dangers of misuse of corticosteroid drugs in treating superficial fungal infections: Presentation of a case series for stricter policy regulation","volume":"4","author":"Akhter","year":"2025","journal-title":"Public Health Chall."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1684\/ejd.2025.4921","article-title":"Epidemiological analysis of dermatophytomas over 15 years in Mexico: Is the concept correct for all fungi?","volume":"35","author":"Arenas","year":"2025","journal-title":"Eur. J. Dermatol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"151","DOI":"10.12788\/cutis.1211","article-title":"The rise of antifungal-resistant dermatophyte infections: What dermatologists need to know","volume":"115","author":"Gold","year":"2025","journal-title":"Cutis"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Gupta, A.K., Wang, T., Mann, A., Piguet, V., Chowdhary, A., and Bakotic, W.L. (2025). Mechanisms of resistance against allylamine and azole antifungals in Trichophyton: A renewed call for innovative molecular diagnostics in susceptibility testing. PLoS Pathog., 21.","DOI":"10.1371\/journal.ppat.1012913"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Gupta, A.K., Nguyen, H.C., Liddy, A., Economopoulos, V., and Wang, T. (2025). Terbinafine resistance in Trichophyton rubrum and Trichophyton indotineae: A literature review. Antibiotics, 14.","DOI":"10.3390\/antibiotics14050472"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1093\/ced\/llaf414","article-title":"Emerging threats in dermatophytosis: Antimicrobial resistance in Trichophyton, with an emphasis on T. indotineae","volume":"51","author":"Tey","year":"2026","journal-title":"Clin. Exp. Dermatol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e00059-22","DOI":"10.1128\/aac.00059-22","article-title":"Gene amplification of CYP51B: A new mechanism of resistance to azole compounds in Trichophyton indotineae","volume":"66","author":"Yamada","year":"2022","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e0160923","DOI":"10.1128\/aac.01609-23","article-title":"The Ptk2\u2013Pma1 pathway enhances tolerance to terbinafine in Trichophyton rubrum","volume":"68","author":"Ishii","year":"2024","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Markantonatou, A.-M., Samaras, K., and Vyzantiadis, T.-A. (2023). Dermatophytic biofilms: Characteristics, significance and treatment approaches. J. Fungi, 9.","DOI":"10.3390\/jof9020228"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e0108725","DOI":"10.1128\/spectrum.01087-25","article-title":"Biofilm development in three-dimensional models infected with Trichophyton rubrum","volume":"13","author":"Cabral","year":"2025","journal-title":"Microbiol. Spectr."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Winter, P., Burmester, A., Tittelbach, J., and Wiegand, C. (2023). A new genotype of Trichophyton quinckeanum with point mutations in Erg11A encoding sterol 14-\u03b1 demethylase exhibits increased itraconazole resistance. J. Fungi, 9.","DOI":"10.3390\/jof9101006"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e0140724","DOI":"10.1128\/jcm.01407-24","article-title":"Treatment and diagnostic challenges associated with the novel and rapidly emerging antifungal-resistant dermatophyte, Trichophyton indotineae","volume":"63","author":"Marbaniang","year":"2025","journal-title":"J. Clin. Microbiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1111\/jdv.20810","article-title":"Trichophyton indotineae: Epidemiology, antifungal resistance and antifungal stewardship strategies","volume":"40","author":"Gupta","year":"2026","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/j.jaad.2024.03.024","article-title":"Clinico-mycological and therapeutic updates on cutaneous dermatophytic infections in the era of Trichophyton indotineae","volume":"91","author":"Khurana","year":"2024","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_42","first-page":"678","article-title":"S1 guideline onychomycosis","volume":"21","author":"Nenoff","year":"2023","journal-title":"J. Dtsch. Dermatol. Ges."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"101638","DOI":"10.1016\/j.hansur.2024.101638","article-title":"Onychomycosis","volume":"43S","author":"Zaraa","year":"2024","journal-title":"Hand Surg. Rehabil."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e0129325","DOI":"10.1128\/aac.01293-25","article-title":"Comparison of gradient concentration strip and EUCAST methods for itraconazole and posaconazole MICs in Trichophyton indotineae","volume":"70","author":"Tireau","year":"2026","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Sacheli, R., Egrek, S., El Moussaoui, K., Kurt, B., Machowski, E., Harag, S., and Hayette, M.-P. (2025). National Belgian study on terbinafine resistance in Trichophyton interdigitale\/mentagrophytes\/indotineae (2022\u20132023): Epidemiology and molecular features. J. Fungi, 11.","DOI":"10.3390\/jof11090676"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"2495","DOI":"10.1007\/s13555-024-01237-6","article-title":"Transungual penetration and antifungal activity of prescription and over-the-counter topical antifungals: Ex vivo comparison","volume":"14","author":"Elabbasi","year":"2024","journal-title":"Dermatol. Ther."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"7799","DOI":"10.1039\/D5RA00387C","article-title":"Lipid-based nanoformulations in onychomycosis therapy: Addressing challenges of current therapies and advancing treatment","volume":"15","author":"Prajapati","year":"2025","journal-title":"RSC Adv."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"2265658","DOI":"10.1080\/09546634.2023.2265658","article-title":"Utility of devices for onychomycosis: A review","volume":"34","author":"Gupta","year":"2023","journal-title":"J. Dermatol. Treat."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"104640","DOI":"10.1016\/j.pdpdt.2025.104640","article-title":"Antimicrobial photodynamic therapy in onychomycosis management: A systematic review of clinical trials","volume":"54","author":"Urzedo","year":"2025","journal-title":"Photodiagnosis Photodyn. Ther."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Giuliani, E., Don\u00e0, M.G., Giglio, A., Abril, E., Sperati, F., Pimpinelli, F., and Latini, A. (2025). Conventional diagnostic approaches to dermatophytosis: Insights from a three-year survey at a public dermatology institute in Italy, 2019\u20132021. Diagnostics, 15.","DOI":"10.3390\/diagnostics15172245"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1016\/j.jaad.2012.10.013","article-title":"Efinaconazole 10% solution in the treatment of toenail onychomycosis: Two phase III multicenter, randomized, double-blind studies","volume":"68","author":"Elewski","year":"2013","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1080\/09546634.2017.1329510","article-title":"Evaluation of the efficacy and safety of tavaborole topical solution, 5%, in the treatment of onychomycosis of the toenail in adults: A pooled analysis of an 8-week post-study follow-up from two randomized phase 3 studies","volume":"29","author":"Gupta","year":"2018","journal-title":"J. Dermatol. Treat."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.jaad.2020.06.055","article-title":"Efficacy and safety of topical terbinafine 10% solution (MOB-015) in the treatment of mild to moderate distal subungual onychomycosis: A randomized, multicenter, double-blind, vehicle-controlled phase 3 study","volume":"85","author":"Gupta","year":"2021","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_54","first-page":"10","article-title":"The role of topical antifungal therapy for onychomycosis and the emergence of newer agents","volume":"7","year":"2014","journal-title":"J. Clin. Aesthet. Dermatol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1111\/1346-8138.14607","article-title":"Efficacy and safety of fosravuconazole L-lysine ethanolate, a novel oral triazole antifungal agent, for the treatment of onychomycosis: A multicenter, double-blind, randomized phase III study","volume":"45","author":"Watanabe","year":"2018","journal-title":"J. Dermatol."},{"key":"ref_56","unstructured":"World Health Organization (2022). WHO Fungal Priority Pathogens List to Guide Research, Development and Public Health Action, World Health Organization."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/15\/7\/634\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T04:47:07Z","timestamp":1783486027000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/15\/7\/634"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,24]]},"references-count":56,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["antibiotics15070634"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics15070634","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,24]]}}}