Overcoming therapeutic resistance in cutaneous dermatophytosis using ablative fractional laser-assisted delivery of topical antifungals.

Dermatophytosis, a contagious fungal infection affecting the skin and nails, is increasingly associated with resistance to oral antifungal medications. Laser-assisted drug delivery is a modern therapeutic approach that has shown promising results in various dermatologic conditions, including onychomycosis. This study aims to evaluate the effectiveness of laser-assisted drug delivery in treating refractory cutaneous dermatophyte infections. This case series included five patients with confirmed refractory cutaneous dermatophytosis, unresponsive to oral antifungal treatment for at least six months. Patients were treated at the dermatology clinic of a medical center hospital between June 2024 and March 2025 with three monthly sessions of ablative fractional laser therapy combined with topical application of clotrimazole and terbinafine creams. Clinical outcomes were assessed using a dermatologist-evaluated improvement score based on standardized photographs: worsened (-1), no change (0), slight improvement (1), moderate improvement (2), and significant improvement (3). Patient satisfaction with the treatment was recorded, along with treatment tolerability and any adverse effects. A total of five patients (mean age [range], 46.2 [39-57] years; male-to-female ratio, 2:3) were enrolled. All patients had previously been treated with various oral antifungal therapies, including fluconazole, terbinafine, itraconazole, and voriconazole, without achieving a clinical response after at least six months of treatment. LADD sessions ranged from 1 to 3, and the follow-up period was 1 to 6 months. The highest clinical response (3) was observed in all five patients, with dramatic improvement in pruritus and high patient satisfaction. The evaluation score was 3 in all patients, indicating significant improvement. The procedure was well tolerated, and no serious side effects were reported. The findings of this case series suggest that laser-assisted drug delivery may be a suitable and effective treatment option for dermatophyte infections that are resistant to oral antifungal therapy.