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Oral Candidiasis — SCE Dermatology MCQ

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EasyCutaneous InfectionOral CandidiasisSCE Dermatology

A 60-year-old man on long-term Prednisolone develops a painless white patch on his buccal mucosa. Biopsy shows oral candidiasis with pseudohyphal invasion of the epithelium. What is the most appropriate treatment?

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Correct answer: C — Topical Nystatin oral suspension

For oral candidiasis (thrush) in an immunosuppressed patient on systemic corticosteroids, first-line treatment is topical Nystatin oral suspension (100000 units/mL, 1 mL QDS for 7 days) or Miconazole oral gel (for mild-moderate disease). Oral Fluconazole is reserved for resistant or severe cases. The pseudohyphae on biopsy confirm invasive candidal infection rather than colonisation. Long-term corticosteroid use causes local and systemic immunosuppression predisposing to oral candidiasis. Prevention strategies include oral hygiene, rinsing mouth after using inhaled corticosteroids (for asthma), and antifungal prophylaxis during high-dose immunosuppression. Resistant candidiasis should prompt consideration of non-albicans species.

Reference: NICE CKS Oral Candidiasis; BNF