++
For further information, see CMDT Part 8-17: Oral Candidiasis
++
Fluctuating throat or mouth discomfort
Associated with systemic or local immunosuppression, such as recent corticosteroid, chemotherapy, or antibiotic use
Erythema of oral cavity or oropharynx with creamy-white, curd-like patches
Rapid resolution of symptoms with appropriate treatment
++
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 human immunodeficiency virus (HIV) infection
Angular cheilitis is also a sign of HIV infection, although it can be seen in nutritional deficiencies
Risk factors
Dentures
Debilitated state, with poor oral hygiene
Diabetes mellitus
Anemia
Chemotherapy or local irradiation
Use of corticosteroids (oral or systemic)
Use of broad-spectrum antibiotics
++
Clinical
A wet preparation using potassium hydroxide will reveal spores and may show nonseptate mycelia
Biopsy will show intraepithelial pseudomycelia of Candida albicans
HIV testing should be considered in patients with no known predisposing cause for Candida overgrowth
++
Medications
Fluconazole (100 mg orally daily 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 orally daily) may be indicated in fluconazole-refractory cases
Newer agents, such as voriconazole, may be needed since many Candida species are resistant to first-line azole medications
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 patients who wear dentures