Hyperplastic candidosis

Fungal infection which is spread by various species of the fungus Candida, a commensal normally found in the oral cavity in more than 40% of the population. The most common species is C. Albicans but other less frequent species – such as C. Dubliniensis, C. Krusei and C. Glabrata – are also known.
Clinically, the following can be distinguished:
Pseudomembranous candidiasis (termed muguet or thrush in infants) which appears as a formation of a white-greyish pseudo-membrane on the oral mucosa, velvety and wrinkled in texture, made up of clusters of hyphae of fungi, flaky epithelium cells, bacteria and residues of various types. The removal of these plaques reveals the presence of an underlying, reddened and painful mucosa, which occasionally bleeds.
Erythematous candidiasis where one or more red lesions are typically present, often situated on the hard palate on the upper side of the tongue (with atrophy of the taste buds).
Angular cheilitis (so-called perleche), which is situated at the labial commissures where the mucosa present a linear erosion/ulcer. It is particularly common in elderly patients, who are partially or totally edentulous, due to a loss of the vertical dimension and susceptibility to the aforementioned bacterial infections.
Denture-related stomatitis, situated on the mucosa and in contact with removable, total or partial dentures (e.g. on the hard palate and the alveolar mucosa, presenting as a red area, which matches the shape of the dentures.
Candidal leukoplakia o hyperplastic candidosis, localised behind the commissures, presenting as single or symmetrical, raised and wrinkled lesions which cannot be removed.
In addition to evident clinical aspects, the patient often will refer to burning symptoms, xerostomia, dysguesia and pain on masticating. Of those factors predisposing to oral candidiasis, systemic (e.g. metabolic syndrome, immune disorders, malnutrition and/or malabsorption, systemic antibiotic therapies, Sjӧgren’s syndrome, concomitant neoplasm) and local factors (poor oral hygiene, smoking, local administration of corticosteroids) can be recognised. Diagnosis can be established by performing a microbiological investigation (e.g. oral swab) to identify fungi and to establish the more sensitive antifungal medication on the basis of an antimycogramm. Moreover, patients should be informed about oral hygiene and the correct cleaning of dentures, where relevant.