Generic Nizoral In The Treatment Of Oral Thrush
It is fungal infection caused by Candida albicans. Though immunosuppression is the main reason for acquiring oral thrush, yet there are a number of factors that are predisposing to Candida infections. It can be due to mechanical factors like; trauma, local occlusion, dentures, occlusive dressings or garments, obesity; Nutritional factors like avitaminosis, iron deficiency and generalized malnutrition; Physiologic alterations like extremes of age, pregnancy and menses; systemic illnesses like Down syndrome, acrodermatitis enteropathica, malignancy, endocrine disease, uremia and immunodeficiency, ; and Iatrogenic causes like indwelling catheters, X-ray radiation, IV lines and medications like steroids.
All these factors mainly increase the pathogenicity of the Candida albicans which would otherwise be normal commensals of the oral cavity.
The most common form of oral thrush is acute pseudomembranous type which almost 1/3 of the HIV patient develop and over 90% of people with acquired immunodeficiency syndrome. It appears as discrete white patches mainly on the buccal mucosa, tongue, palate and Gingivae. This friable pseudo membrane resembles milk curds which consist of desquamated epithelial cells, fungal elements, inflammatory cells, and fibrin and food debris. Scraping the patches exposes a bright erythematous surface underneath.
Acute atrophic candidiasis or erythematous candidiasis commonly occurs after sloughing of the thrush pseudo membrane. It is mainly associated with broad spectrum antibiotic therapy, glucocorticoid use and HIV. It commonly occurs on the dorsal surface of the tongue. It may be either symptomatic or asymptomatic. Burning sensation or pain is the most common symptom.
Chronic atrophic candidiasis also known as denture stomatitis is seen in 24-60% of people with dentures. Females are more affected than male. Clinically it presents as chronic erythema and edema of palatal mucosa that contacts the dentures and angular cheilitis. Dentures actually cause low grade trauma and occlusion which predisposes to candidal colonization and infection.
Generic Nizoral or Ketoconazole is also used in the treatment of Oral Thrush.
Candidal chielosis, also known as angular cheilitis, is called as perleche and is characterized by erythema, fissuring, maceration and soreness at the angles of the mouth. In the young it is commonly seen among habitual lip lickers whereas in the elderly, it is associated with sagging skin at the oral commissure. Predisposing factors for this condition includes loss of dentition, poor fitting dentures, and malocclusion and riboflavin deficiency.
A thrush like condition can be seen in other diseases like lichen planus, herpetic infections, erythema multiformae, and pernicious anemia. So a careful history, clinical diagnosis and lab diagnosis is essential to rule out these differential diagnoses.
Once confirmed about the oral thrush, the etiology must be found out for complete treatment. Say for instance, for a person with HIV infection suffering from thrush, ART should be given along with this antifungal treatment. Or else the infection would recur if you fail to treat the HIV infection. In uncomplicated cases of thrush, nystatin suspensions should be given 400,000 to 600,000 units 4 times/day. Or it can be treated with Clotrimazole touches 10 mg dissolved in mouth 5 times/ day. In recurrent cases, oral azoles can be given like Flucanazole, Itraconazole, etc.
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