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Oral candidosis in lichen planus: the diagnostic approach is of major therapeutic importance

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Abstract

Objectives

Candida albicans is the most common fungal pathogen in humans, but other Candida species cause candidosis. Candida species display significant differences in their susceptibility to antimycotic drugs. Patients with symptomatic or erythematous oral lichen planus (OLP) commonly have Candida infection requiring correct identification of Candida species in order to initiate adequate antimycotic therapy. Therefore, conventional cytosmear and culture tests were compared with genetic diagnostics on oral rinse followed by agar culture and material collected by cytobrush from OLP patient mucosal lesion.

Methods

The genetic approach was validated on a reference panel of 60 well-defined unrelated fungal species. The study included 37 OLP patients. Oral candidosis (OC) was established based on clinical signs of OC and/or oral mucosal symptoms and at least one hypha in lesional cytosmear. Antimycotic treatment was initiated after OC diagnosis, and symptomatic treatment was initiated in no-candidosis situations.

Results

The composition of Candida species in oral rinse/culture test was different from that of lesional cytobrush sampling as more non-albicans species were detected by the latter. Unexpectedly, Candida dubliniensis was found to be overrepresented among patients with a history of antimycotic treatment indicating unintentional iatrogen selection. Of the 22 OLP patients receiving treatment, 27 % of these should have been offered alternative therapy based on the improved diagnostic approach.

Conclusion

This study highlights the importance of lesional sampling in OLP patients with suspected OC.

Clinical relevance

Correct fungal identification is critical in order to initiate adequate antimycotic therapy, thus minimizing iatrogen selection of non-albicans species.

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Acknowledgments

The authors wish to thank statistician Claus Jensen, UNI C Statistics & Analysis for statistical assistance, Maiken Cavling Arendrup, DMS, PhD, SSI for access to all Candida reference strains included in this study, and Camilla Andersen for technical assistance. This study was supported by funds from the Danish Agency for Science Technology and Innovation and Dansk Tandlægeforening.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Oral Medicine, Section of Oral Pathology & Medicine, Institute of Odontology, University of Copenhagen, Norre Alle 20, DK-2200, Copenhagen N, Denmark

    C. Kragelund, L. Kieffer-Kristensen & J. Reibel

  2. Department of Oral Diagnostics, Institute of Odontology, University of Copenhagen, Norre Alle 20, DK-2200, Copenhagen N, Denmark

    L. Kieffer-Kristensen & E. P. Bennett

Authors
  1. C. Kragelund
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  2. L. Kieffer-Kristensen
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  3. J. Reibel
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  4. E. P. Bennett
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Corresponding authors

Correspondence to C. Kragelund or E. P. Bennett.

Additional information

C. Kragelund and L. Kieffer-Kristensen contributed equally to the work presented.

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Kragelund, C., Kieffer-Kristensen, L., Reibel, J. et al. Oral candidosis in lichen planus: the diagnostic approach is of major therapeutic importance. Clin Oral Invest 17, 957–965 (2013). https://doi.org/10.1007/s00784-012-0757-6

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  • DOI: https://doi.org/10.1007/s00784-012-0757-6

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