Onychomycosis: Molecular Testing and Antifungal Resistance

As global reports of antifungal-resistant superficial mycoses escalate, healthcare providers encounter growing challenges in effectively diagnosing and managing recalcitrant onychomycosis. This clinical presentation examines the evolving epidemiology of dermatophyte resistance—focusing on squalene epoxidase gene mutations that compromise terbinafine efficacy—and provides practical guidance on diagnosing this resistance. Clinicians will gain critical insights into the comparative accuracy of fungal culture, histopathology, and PCR assay testing, while reviewing actionable approaches and apply antifungal stewardship in daily practice