Like hairy leukoplakia, oral candidiasis is highly prevalent in HIV-infected individuals. Pseudomembranous candidiasis appears as creamy, white, removable plaques that can be found anywhere in the mouth or pharynx. These plaques are caused by overgrowth of fungal hyphae mixed with desquamate epithelium and inflammatory cells. Erythematous candidiasis presents as flat, subtle, red patches of varying sizes on any mucosal surface, commonly the palate and dorsal surface of the tongue.
Angular cheilitis involves fissuring and cracking at the corners of mouth.
Occasionally, all three types appear in the same individual. The diagnosis of oral candidiasis is usually made from the appearance of the lesions, but the presence of hyphae and blastospores, seen on smears examined with potassium hydroxide or Gram stain, can help confirm the diagnosis. Oral candidiasis may be treated with either topical or systemic antifungal agents. The choice of medication depends on a variety of factors, including other, concomitant medications, evidence of abnormal liver function, patient preference and compliance, and the sugar content of topical preparations. Nystatin oral suspension has a high sugar content and its relatively short time in contact with the oral mucosa makes it less effective.