Current challenges and drug delivery updates in vulvovaginal candidiasis treatment: A comprehensive review

To provide a comprehensive summary of a decade (2014-2025) of high-quality research from Q1 to Q3 journals on formulation development and improved drug-delivery methods for vulvovaginal candidiasis, addressing the limits of conventional antifungal therapy. A detailed narrative review was carried out using PubMed, Scopus, Springer, Wiley, Frontiers, ClinicalTrials.gov, and Google Scholar. To maintain scientific rigor, only the most relevant Q1-Q3 indexed publications were included. Studies published in the last 11 years have been evaluated for their relevance to vaginal drug delivery systems and antifungal formulations. Data were systematically retrieved and described in text and tables, with 203 formulation techniques given, including nanoparticles, vesicular carriers, mucoadhesive systems, thermosensitive gels, electrospun nanofibers, microneedles, and three-dimensional printed dosage forms. The key outcomes examined were vaginal retention, drug release behavior, mucosal penetration, antibiofilm activity, and antifungal efficacy. In comparison to conventional formulations, advanced drug-delivery systems displayed longer vaginal residence time, sustained drug release, and improved tissue penetration. Nanoparticle-based and mucoadhesive systems demonstrated increased antifungal effectiveness against both microbial and biofilm-associated Candida species, with absolute fungal clearance improvements ranging from 25 to 45% in preclinical applications. This review combines 11years of formulation research, minimizing the need for readers to sift over fragmented literature. Major limitations included study design variability and a lack of long-term clinical data. This 11-year synthesis identifies improved drug-delivery technologies as promising patient-centered solutions for overcoming resistance, recurrence, and poor drug retention in vulvovaginal candidiasis treatment. These drug delivery systems constitute an important step toward next-generation antifungal therapy and better clinical outcomes.