Oral candidiasis

By
Amr Mohammad Ammar, MD
Lecturer of dermatology, venereology and andrology
Faculties of Medicine, Dental medicine and physical therapy, Al-Azhar
university, ECU , Cairo, Egypt
It is an infection caused by Candida albicans,
occasionally by other species of candida.
Candida can infect skin, mucous membranes and
internal organs.
Predisposing factors
• Diabetes, Cushing's syndrome, Addison's disease.
• Iron deficiency.
• Hypothyroidism and hypoparathyroidism.
• Obesity.
• Pregnancy.
• HIV, malnutrition and debilitating states.
• Local environment of moisture, warmth, maceration &
occlusion.
• Systemic administration of antibiotics, corticosteroids,
contraceptive pills and immunosuppressive therapy.
Clinical features:
(1) Oral candidiasis: in the form of oral thrush or angular
stomatitis.
(2) Candida intertrigo: affects skin fold with erythema and
moist exudates with satellite lesions.
(3) Vulvovaginitis: presents with itching and soreness and a
thick, creamy white vaginal discharge.
(4) Candida balanitis: affects the glans penis, especially in
the
uncircumcised males.
(5) Perianal candidiasis: with erythema, soreness and irritation.
(6) Napkin candidiasis: affects skin of buttocks and genitalia of
the infant.
(7) Candida paronychia and onychomycosis: this is a form of
chronic paronychia; the nail fold is red and swollen.
There is nail dystrophy with discoloration of the nail plate and
onycholysis.
Diagnostic methods for candida infection
1. Direct examination of swab taken from skin or
mucous
membrane by KOH preparation will reveal budding
yeasts
with or without hyphae.
2. Culture on fungal media.
Treatment of candidiasis
(1) Prophylactic measures: avoid predisposing factors.
(2)Topical treatment:
• Imidazoles derivatives.
• Allylamines (naftifine).
• The pyridone dervative (ciclopirox).
• Polyene antibiotic (nystatin).
Systemic therapy
• Nystatin tablets, 500,000 units tid in recurrent or
recalcitrant perianal, vulvar, or diaper- area
involvement(nystatin is not absorbed by GIT).
• Oral imidazoles and triazoles in chronic mucocutaneous
candidiasis and recalcitrant candidal onychomycosis.
Amr Mohammad Ammar, MD