GPAtlas🧭 When to suspect
Oral candidiasis is an opportunistic infection of the oral mucosa, usually by Candida albicans, a commensal that overgrows when local or systemic host defences are disturbed. It is largely a clinical diagnosis, and the two skills that matter in primary care are to recognise its different forms and to identify the predisposing factor – because in an otherwise well adult, candidiasis can be the first sign of an undiagnosed condition such as diabetes or human immunodeficiency virus (HIV) infection.
Suspect it with white patches that wipe off leaving a red, sore base, or with red, sore mucosa under a denture or on the tongue. Raise suspicion further with risk factors: recent broad-spectrum antibiotics, inhaled corticosteroids (ICS) or systemic steroids, diabetes (especially if poorly controlled), immunosuppression (HIV, chemotherapy, transplant, biologics), denture wear, dry mouth (xerostomia), smoking, the extremes of age, and haematinic deficiency (iron, B12, folate).
| Clinical form | Appearance | Typical setting |
|---|---|---|
| Pseudomembranous (acute – classic “thrush”) | Creamy white plaques that wipe off, leaving a red or bleeding base | Infants, ICS use, post-antibiotic, immunosuppression |
| Erythematous / atrophic (acute) | Smooth, sore, red mucosa, often on the dorsum of the tongue | Classically a “sore mouth” after a course of antibiotics |
| Denture stomatitis (chronic atrophic) | Diffuse erythema confined to the denture-bearing palate | Denture wearers – often painless; treat the denture |
| Angular cheilitis | Sore red fissuring and maceration at the corners of the mouth | Often mixed Candida and Staphylococcus aureus |
| Chronic hyperplastic (candidal leukoplakia) | White plaque that does not wipe off, usually at the buccal commissure | Smokers – has malignant potential, so refer |
Source: DermNet
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