Urushiol, the principal bioactive component of natural lacquer, has emerged as a promising candidate for developing eco-friendly antimicrobial coatings due to its unique catechol structure and long alkyl chains. This review systematically elucidates the molecular mechanisms underpinning urushiol's broad-spectrum antimicrobial activity, including membrane disruption via hydrophobic interactions, oxidative stress induction through redox-active phenolic groups, and enzyme inhibition via hydrogen bonding. Recent advances in urushiol-based composite systems-such as metal coordination networks, organic-inorganic hybrids, and stimuli-responsive platforms-are critically analyzed, highlighting their enhanced antibacterial performance, environmental durability, and self-healing capabilities. Case studies demonstrate that urushiol derivatives achieve >99% inhibition against both Gram-positive and Gram-negative pathogens, outperforming conventional agents like silver ions and quaternary ammonium salts. Despite progress, challenges persist in balancing antimicrobial efficacy, mechanical stability, and biosafety for real-world applications. Future research directions emphasize precision molecular engineering, synergistic multi-target strategies, and lifecycle toxicity assessments to advance urushiol coatings in medical devices, marine antifouling, and antiviral surfaces. This work provides a comprehensive framework for harnessing natural phenolic compounds in next-generation sustainable antimicrobial materials.