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Key Features

  • Fluctuating throat of mouth discomfort

  • Systemic or local immunosuppression

  • Erythema of oral cavity or oropharynx with fluffy, white patches

  • Rapid resolution of symptoms with appropriate treatment

Clinical Findings

  • Painful creamy-white curd-like patches

  • White patches can be easily rubbed off by a tongue depressor, unlike leukoplakia or lichen planus, revealing an underlying irregular erythema

  • Often the first manifestation of HIV infection

  • Angular cheilitis is a sign, although it can be seen in nutritional deficiencies

  • Risk factors

    • Dentures

    • Debilitated states

    • Poor oral hygiene

    • Diabetes mellitus

    • Anemia

    • Chemotherapy or local irradiation

    • Use of corticosteroids (oral or systemic) or broad-spectrum antibiotics

Diagnosis

  • Clinical

  • A wet preparation using potassium hydroxide will reveal spores and may show nonseptate mycelia

  • Biopsy will show intraepithelial pseudomycelia of Candida albicans

Treatment

  • Medications

    • Fluconazole (100 mg daily orally for 7 days); shorter duration therapy is also effective

    • Ketoconazole (200–400 mg orally with breakfast [requires acidic gastric environment for absorption] for 7–14 days)

    • Clotrimazole troches (10 mg dissolved orally five times daily)

    • Nystatin mouth rinses (500,000 units [5 mL of 100,000 units/mL] held in the mouth before swallowing three times daily)

  • In HIV infection, longer courses of fluconazole therapy may be needed, and itraconazole (200 mg daily orally) may be indicated in fluconazole-refractory cases

  • Newer agents, eg, voriconazole, may be needed since many Candida species are resistant to first-line azole drugs

  • 0.12% chlorhexidine or half-strength hydrogen peroxide mouth rinses may provide local relief

  • Nystatin powder (100,000 units/g) applied to dentures and rinsed off three or four times daily for several weeks may help denture wearers

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