Fungal infection of oral mucosa

As the saying goes, diseases come from the mouth, and oral diseases are mostly fungal infections. Oral fungal infections can be divided into Candida stomatitis, Candida cheilitis, angular cheilitis, and chronic mucocutaneous candidiasis according to the site of the lesion. Other oral diseases related to Candida albicans infection include lichen planus, hairy tongue and median rhomboid glossitis. What are the common symptoms of these diseases? What kind of treatment is needed and what should we pay attention to during the treatment?

Candidal stomatitis is further divided into acute pseudomembranous type (thrush), acute atrophic type (antibiotic stomatitis), chronic hypertrophic type (proliferative Candidal stomatitis) and chronic atrophic type (denture stomatitis). The acute pseudomembranous type is thrush. Acute atrophic candidal stomatitis is more common in adults, often due to long-term use of broad-spectrum antibiotics. Most patients suffer from wasting diseases such as leukemia, malnutrition, endocrine disorders, and after tumor chemotherapy. Certain skin diseases such as systemic lupus erythematosus, psoriasis, pemphigus, etc. may also cause candidal stomatitis during the large-scale use of penicillin and streptomycin. Therefore, this type is also called antibiotic stomatitis. It should be noted that this type of acute candidal stomatitis in adults may have pseudomembranes and be accompanied by angular cheilitis, but sometimes the main manifestations are mucosal congestion and erosion, and the papillae on the dorsal tongue are atrophic and lumpy, with thickening of the surrounding tongue coating.

Patients often first have abnormal taste or loss of taste, dry mouth, and burning pain in the mucosa. The chronic hypertrophic type is also called proliferative Candidal stomatitis and can be seen on the buccal mucosa, dorsum of the tongue and palate. Because the hyphae penetrate deep into the mucosa or skin, they cause parakeratosis, acanthosis, epithelial hyperplasia, microabscess formation and inflammatory cell infiltration of the papillae of the lamina propria, while the pseudomembrane on the surface is tightly attached to the epithelial layer and is not easy to peel off. This type of disease has the potential for malignant transformation, so elderly patients in particular should be vigilant and strive for early biopsy to confirm the diagnosis. The chronic atrophic type, also known as denture stomatitis, is often caused by the palate and gingival mucosa in contact with the palatal side of the maxillary denture, and is more common in female patients. The mucosa appears bright red edema, or yellow-white linear or spotted pseudomembrane. Candida albicans can be found in plaques or pseudomembranes in 90% of patients, and 80% of patients with Candida cheilitis or angular cheilitis have denture stomatitis.

Candidal cheilitis is more common in people over 50 years old. It usually occurs on the lower lip, and may occur at the same time as Candida stomatitis or angular cheilitis. It is characterized by bilateral involvement, cracking of the skin and mucous membranes in the corners of the mouth, congestion of the adjacent skin and mucous membranes, erosion and exudate in the cracks, or thin scabs, pain or bleeding when opening the mouth. Candida angular cheilitis often occurs in children, weak patients and patients with blood diseases. Chronic mucocutaneous candidiasis is a special type of Candida albicans infectious disease, in which the lesions involve the oral mucosa, skin and nail bed. Most of the diseases start in childhood and last for several years to several decades, often accompanied by endocrine or immune dysfunction and low cellular immunity. Therefore, this group of diseases is actually a manifestation of a syndrome.