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The biofilm matrix acts as a physical barrier to block antifungal penetration, and the sessile fungal cells exhibit metabolic dormancy and upregulated expression of drug efflux pumps and target-modifying genes, and the presence of drug-resistant cells are some of the main factors leading to immune evasion and weakened response to available drugs (Sahoo et al., 2025)

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10.1016/j.celrep.2014.07.030 [DOI] [PMC free article] [PubMed] [Google Scholar] Farkas J

moderate evidence supports the use of capsaicin cream or a lidocaine patch as a second-line agent