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For further information, see CMDT Part 8-17: Oral Candidiasis
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Fluctuating throat or mouth discomfort
Systemic or local immunosuppression
Erythema of oral cavity or oropharynx with creamy-white, curd-like patches
Rapid resolution of symptoms with appropriate treatment
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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 also a sign of HIV infection, although it can be seen in nutritional deficiencies
Risk factors
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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