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Oral candidiasis (thrush) is usually painful and looks like creamy-white curd-like patches overlying erythematous mucosa. Because these white areas are easily rubbed off (eg, by a tongue depressor)—unlike leukoplakia or lichen planus—only the underlying irregular erythema may be seen. Oral candidiasis is commonly encountered among denture wearers; in debilitation, diabetes, and anemia; in those undergoing chemotherapy or local irradiation; and in patients receiving corticosteroids or broad-spectrum antibiotics. Candidiasis is often seen prior to other manifestations of HIV infection in high-risk groups. Angular cheilitis is also a manifestation of candidiasis, though it is also seen in nutritional deficiencies.
The diagnosis is usually not difficult—painful intraoral white patches on an erythematous base in a patient at risk for candidiasis. A wet preparation of a smear with potassium hydroxide will confirm spores and may show nonseptate mycelia. Biopsy will show intraepithelial pseudomycelia of Candida albicans.
Effective antifungal therapy may be achieved with any of the following: fluconazole (100 mg daily for 7–14 days), ketoconazole (200–400 mg with breakfast [requires acidic gastric environment for absorption] for 7–14 days), clotrimazole troches (10 mg dissolved orally five times daily), or nystatin vaginal troches (100,000 units dissolved orally five times daily) or mouth rinses (500,000 units [5 mL of 100,000 units/mL] held in the mouth before swallowing three times daily). Shorter-duration therapy has also proved effective in many cases, using, for instance, fluconazole. In addition, 0.12% chlorhexidine or half-strength hydrogen peroxide mouth rinses may provide local relief. Nystatin powder (100,000 units/g) applied to dentures three or four times daily for several weeks may help denture wearers.
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