How should severe and persisting oral candidiasis best be tackled?
Severe or persistent candidal infection is likely to be a feature of a longstanding underlying local, or less commonly systemic condition. Thrush (yellowy-white non-adherent curds typically of the soft palate) is usually the consequence of long-term use of steroid inhalers. This may be lessened by rinsing of the mouth following inhaler use and/or topical antifungal therapy. Systemic therapy should be avoided in view of the potential for developing azole-resistant strains. Thrush may also be a short-term consequence of broad-spectrum antibiotic or systemic steroid therapy – when the candidal infection only warrants therapy if symptomatic (unlikely) or the anti-biotic/steroid therapy is likely to be long term. Median rhomboid glossitis is usually a painless, red patch in the centre of the dorsum of the tongue. It arises as a consequence of long-term smoking, xerostomia or immunodeficiency (such as HIV). Aside from tackling the underlying problem, topical and/or systemic antifungals shoul
