Candidosis and infection
Consider predisposing factors such as dentures, inhaled steroids, dry mouth and immunosuppression. Treat the cause as well as the visible infection.
Understand
Candidosis can be pseudomembranous, erythematous or denture-associated. Colonisation without clinical disease does not always require treatment.
Assess
Look for inhaled steroid use, dentures worn overnight, xerostomia, antibiotics, diabetes and immunosuppression. Consider alternative diagnoses for a non-wipeable patch.
Apply
Address predisposing factors, hygiene and denture fit alongside indicated antifungal treatment. Persistent or recurrent disease needs a broader assessment rather than repeated prescriptions alone.
Key distinctions
Pseudomembranous candidosis can wipe away, whereas erythematous disease may appear as soreness or depapillation. Denture-associated changes can persist if an appliance is worn continuously or poorly cleaned. Recurrent disease should prompt review of dry mouth, diabetes, inhaled steroid technique and immunosuppression. Failure of treatment also raises the possibility that the original diagnosis was wrong.
Think through a case
A denture wearer has recurrent erythema beneath an upper plate and sleeps in it nightly. Hygiene and overnight removal matter alongside any medicine.
The distinction to remember
Do not call a persistent non-wipeable patch candidosis solely because antifungal treatment was tried before.
Test your recall
Why review predisposing factors in recurrent candidosis?
Show answer
Without addressing them, recurrence is more likely.