Update: Dermatophyte Management, Stewardship, Emerging Dermatophyte Resistance and Options Available

The presentation focuses on the management of onychomycosis, emphasizing the importance of antifungal stewardship. The speaker highlights the necessity of confirming a diagnosis through laboratory testing rather than solely relying on clinical signs. Historically, antifungal drugs such as terbinafine and itraconazole have been used, but resistance to these medications is becoming a significant issue, with ongoing cases of terbinafine resistance being reported globally. The cure rates for these traditional treatments are also noted to be low, prompting the speaker to advocate for more aggressive treatment approaches and the potential use of higher doses or alternative medications like itraconazole for resistant cases. The speaker shares clinical examples of patients who have faced treatment-resistant fungal infections, detailing challenges encountered and various strategies attempted to achieve successful outcomes. The state of fungal resistance calls for careful consideration in prescribing practices, with the importance of thorough diagnosis and adequate treatment duration being underscored to prevent the development of further resistance.