Etiology • Infection with a fungal organism of the Candida species, usually
Candida albicans • Associated with predisposing factors: most commonly,
immunosuppression, diabetes mellitus, antibiotic use, or xerostomia (due to lack of protective effects of saliva)
Clinical Presentation • Acute (thrush)
• Pseudomembranous • Painful white plaques representing fungal colonies on
inflamed mucosa • Erythematous (acute atrophic): painful red patches caused
by acute Candida overgrowth and subsequent stripping of those colonies from mucosa
Candida albicans • Associated with predisposing factors: most commonly,
immunosuppression, diabetes mellitus, antibiotic use, or xerostomia (due to lack of protective effects of saliva)
Clinical Presentation • Acute (thrush)
• Pseudomembranous • Painful white plaques representing fungal colonies on
inflamed mucosa • Erythematous (acute atrophic): painful red patches caused
by acute Candida overgrowth and subsequent stripping of those colonies from mucosa
• Chronic • Atrophic (erythematous): painful red patches; organism
difficult to identify by culture, smear, and biopsy • “Denture-sore mouth”: a form of atrophic candidiasis
associated with poorly fitting dentures; mucosa is red and painful on denture-bearing surface
• Median rhomboid glossitis: a form of hyperplastic candidiasis seen on midline dorsum of tongue anterior to circumvallate papillae
• Perlèche: chronic Candida infection of labial commissures; often co-infected with Staphylococcus aureus
• Hyperplastic/chronic hyperplastic: a form of hyperkeratosis in which Candida has been identified; usually buccal mucosa near commissures; cause and effect not yet proven
• Syndrome associated: chronic candidiasis may be seen in association with endocrinopathies
Diagnosis • Microscopic evaluation of lesion smears
• Potassium hydroxide preparation to demonstrate hyphae • Periodic acid–Schiff (PAS) stain • Culture on proper medium (Sabouraud’s, corn meal, or
potato agar) • Biopsy with PAS, Gomori’s methenamine silver (GMS), or
other fungal stain of microscopic sections
Differential Diagnosis • Allergic or irritant contact stomatitis • Atrophic lichen planusTreatment • Topical or systemic antifungal agents
White Lesions 5
• For immunocompromised patients: routine topical agents after control of infection is achieved, usually with systemic azole agents
• See “Therapeutics” section • Correction of predisposing factor, if possible • Some cases of chronic candidiasis may require prolonged
therapy (weeks to months). Prognosis
• Excellent in the immunocompetent host