DOI: https://doi.org/10.36347/sjams.2026.v14i02.019

Pages: 254-258

Background: Recalcitrant dermatophytosis, characterized by persistent or recurrent infections of the skin, hair, and nails, poses a growing clinical challenge due to increasing resistance to conventional antifungal therapies. Terbinafine, a widely used systemic antifungal, has moderate efficacy in resistant cases, whereas voriconazole, a broad-spectrum triazole, has demonstrated faster and higher cure rates with lower relapse. This study aimed to compare the efficacy and safety of oral terbinafine versus voriconazole in patients with recalcitrant dermatophytosis by evaluating clinical cure, symptom relief, overall treatment response, and adverse effects. Methods: This prospective comparative study was conducted from January to December 2023, enrolling 60 adult patients with clinically and mycologically confirmed recalcitrant dermatophytosis. Patients were randomly assigned to receive either oral terbinafine (250 mg twice daily, n = 30) or oral voriconazole (200 mg twice daily, n = 30) for 4 weeks. Outcomes assessed included clinical and mycological cure, time to symptom relief, recurrence, and adverse effects. Data were analyzed using SPSS v25, with p < 0.05 considered significant. Results: The study population was predominantly 31–45 years old, male, and from rural areas. Common clinical features included pruritus, erythema, and scaling, with 61.7% of patients having disease duration over 6 months. At 4 weeks, voriconazole achieved higher complete cure rates (76.7% vs. 63.3%) and faster symptom relief than terbinafine. Both drugs were well tolerated, with only mild and infrequent adverse effects reported. Conclusion: Voriconazole demonstrated superior efficacy and more rapid symptom improvement compared to terbinafine in recalcitrant dermatophytosis, while both medications were generally safe and well tolerated, supporting the use of voriconazole as an effective alternative in resistant cases.