Treatment Strategies for Controlling Antifungal Resistance in Candida Onychomycosis Publisher



Tamimi P ; Ghaderi A ; Firooz A ; Sayyahfar S ; Fattahi M
Source: Archives of Dermatological Research Published:2026

Abstract

Onychomycosis caused by Candida (Candida onychomycosis) is prevalent, especially among people with defective immunity status. Drug resistant candidiasis is seen nowadays more than the past because of inappropriate treatment or failure. The present narrative review highlights considerations in onychomycosis treatment caused by Candida species. The review was conducted on the available literature featured on PubMed and Google Scholar. The search terms were the following: Candida spp. Onychomycosis and treatment. The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, reviews, and case reports. The search was restricted to articles written in the English language. Moreover, duplicate articles and non-available full-text articles were excluded. The extracted data of the search results were retrieved in this study. Antifungal susceptibility testing (AST) is essential for choosing effective treatments as resistance to antifungals rises among non-albicans Candida spp. Standard treatments for onychomycosis include systemic agents like itraconazole and fluconazole, which are more effective than topical options, especially for proximal infections. Patient compliance and care strategies are vital for success, with topical agents being preferred for elderly patients unless systemic treatment is necessary. The review emphasizes the need for accurate pathogen identification and AST, particularly with resistant strains like Candida glabrata (Nakaseomyces glabratus), and summarizes management strategies across age groups. © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2025.