Candida – Thrush

Thrush is a condition I rarely encounter in my Woodlands dermatology and Conroe dermatology offices as it usually occurs in hospitalized patients who are immunosuppressed.  In an outpatient clinic, the most common cause of thrush is patients who have been on a long course of broad spectrum antibiotics, which have reduced the normal bacterial flora and allowed Candida to overpopulate the oral mucosa.  It can also occur in patients who are elderly, diabetic, malnourished and can be the first clinical manifestation of AIDS.  Also, having a very dry mouth can result in the overgrowth of Candida leading to thrush as saliva normally inhibits the proliferation of Candida.  Clinically, white membranes cover the oral mucosa and when removed can cause the underlying tissue to bleed.  Occasionally, the white membranes can extend to the corner of the mouth to form perleche.  The tongue usually appears bright red and the normal papillae found on the surface of the tongue are absent leading to a very shiny, smooth appearance.  Treatment involves Nystatin solution which is swished around the oral cavity and spat out every 2-3 hours and a one time dose of fluconazole (Diflucan) 150mg.  In immunosuppressed patients, a much longer and higher dose regimen of fluconazole may be needed.