Dr\ Adel Albattah

Pseudomembranous Candidiasis and Erythematous

Candidiasis

Pseudomembranous candidiasis (Mouth thrush):

Clinically it appears as creamy, lightly adherent plaques on an
erythematous oral mucosa, usually on the cheek, palate,
tongue, labial or oropharynx.

Scraped away to expose an underlying erythematous base.

Erythematous candidiasis(Atrophic):
Red patches on the tongue or palate with burning sensation.
Chronic hyperplastic candidiasis (candidal leukoplakia)
More commonly seen in smokers.

Typically presents as a white patch on the oral buccal mucosa

bilaterally.

Although there is an ↑ risk of malignant change.

Leukoplakia is described as white patch or plaque that cannot be

characterized clinically or pathologically as any other disease and
is not associated with any physical or chemical agent except the
use of tobacco (WHO).
Several patient groups are predisposed to pseudomembranous
Candidiasis and erythematous Candidiasis infections, e.g.,
-Infancy and old aged,
-Patients taking inhaled corticosteroids,

- Patients taking cytotoxics or broad-spectrum antibacterials,

-Diabetic patients,

-Patients with nutritional deficiencies, or

-Patients with serious systemic disease associated with reduced

immunity (such as leukaemia, other malignancies and HIV
infection).
 Treatment
a)Local Measures:( to be used in the first instance)
Advise patients who use a corticosteroid inhaler to rinse their
mouth with water or brush their teeth immediately after using
the inhaler.
b)Antifungal drugs:
-Topical antifungal drugs:
-Systemic antifungal drugs:
-If fluconazole and miconazole are contraindicated, an
appropriate regimen is:
 Denture stomatitis
Denture stomatitis can be treated effectively by local measures.

However, antifungal agents can be used as an adjunct to these

local measures.

Chlorhexidine mouthwash is also effective against fungal

infections.

a)Local Measures: ( to be used in the first instance)

Advise the patient to:

-Brush the palate daily to treat the condition;

-Clean their dentures thoroughly (by soaking in chlorhexidine
mouthwash or sodium hypochlorite for 15 minutes twice daily.

(note that hypochlorite should only be used for acrylic dentures);

-Leave their dentures out as often as possible during the treatment

period.

-If dentures themselves are identified as contributing to the

problem, ensure the dentures are adjusted or new dentures are
made to avoid the problem recurring.
b)Antifungal drugs:
If fluconazole and miconazole are contraindicated, an appropriate
regimen is:
 Angular cheilitis
Discomforting cracking or fissuring of the angles of mouth.

Angular cheilitis in denture-wearing patients is usually caused by

infection with Candida spp. and there is an associated denture
stomatitis that should be treated concurrently.

In those without dentures, angular cheilitis is more likely to be

caused by infection with Streptococcus spp. Or Staphylococcus
spp.

Miconazole cream is effective against both Candida and Gram-

positive cocci and is therefore appropriate to use for all patients.

Where the condition is clearly bacterial in nature, sodium fusidate

(fusidic acid) ointment can be used.
Unresponsive cases can be treated with miconazole and
hydrocortisone cream or ointment.

Continue treatment until clinical resolution is achieved.

A lack of clinical response might indicate predisposing factors such

as a concurrent hematinic deficiency or diabetes.

If dentures themselves are identified as contributing to the

problem, ensure the dentures are adjusted or new dentures are
made to avoid the problem recurring.
Treatment