Oral Liken Planusta Kandidiazis: Aşırı Topikal Kortikosteroid Kullanımına Bağlı Komplikasyon

Abstract

Topikal kortikosteroidler, ağrı ve enflamasyonu hafifletme konusundaki etkinlikleri nedeniyle semptomatik oral liken planusun (OLP) temel tedavi seçeneğini oluşturur. Ancak ilacın etkinlik gücü, kullanım süresi, sıklığı ve uygulanma bölgesi gibi faktörlere bağlı olarak sekonder oral kandidiazis (OK) gibi yan etkilere yol açabilirler. Bu çalışmada, OLP tedavisinde topikal steroid kullanımına bağlı olarak gelişen bir OK olgusu sunulmakta ve hasta uyumunun tedavideki önemi vurgulanmaktadır. Dört ay önce kutanöz liken planus tanısı konmuş olan 78 yaşındaki kadın hasta, yeni ortaya çıkan oral lezyonların değerlendirilmesi amacıyla kliniğimize sevk edilmiştir. İntraoral muayenede bukkal ve labial mukozada, ayrıca dilde eroziv OLP lezyonları tespit edilmiştir. Hastaya, günde iki kez kullanılmak üzere mometazon furoat %0,05 sprey reçete edilmiştir. Hastanın ilacı önerilenden daha yüksek doz ve sıklıkta kullanması sonucunda, iki hafta sonraki kontrol randevusunda bukkal mukozada ve yumuşak damakta psödomembranöz OK gözlenmiştir. Hastaya günde dört kez gargara yapması için nystatin oral süspansiyon (100.000 IU) reçete edilmiş ve 14 gün içinde OK tamamen ortadan kalkmıştır. Sonraki süreçte, topikal steroidlerin uygun şekilde kullanımıyla OLP lezyonları retiküler forma dönmüştür. Hasta, kliniğimizde düzenli takip altında tutulmaktadır. Sekonder OK, OLP’nin klinik belirtilerini ve semptomlarını gizleyerek ve/veya şiddetlendirerek tedavi sürecini olumsuz etkileyebilir. Farmakoterapinin dikkatli bir şekilde izlenmesi ve sekonder OK için erken müdahale, optimal tedavi sonuçlarının elde edilmesinde kritik öneme sahiptir.

Keywords

• yan etki
• oral liken planus
• sekonder oral kandidiazis
• topikal kortikosteroid

Candidiasis in Oral Lichen Planus: Complication of Topical Corticosteroid Overuse

Abstract

Topical steroids represent the mainstay of management for symptomatic oral lichen planus (OLP), owing to their effectiveness in alleviating pain and inflammation. However, their use may result in adverse effects, such as secondary oral candidiasis (OC), influenced by factors including their potency, duration and frequency of use, and site of application. This study presents a case of OC following topical steroid therapy for OLP, emphasizing the importance of patient compliance in treatment. A 78-year-old woman diagnosed with cutaneous lichen planus four months prior was referred to our clinic for evaluation of new oral lesions. Erosive OLP lesions on the buccal and labial mucosa and tongue were noted upon intraoral examination. The patient was prescribed mometasone furoate 0.05% spray to be used twice daily. As a result of the patient using the medication at a higher dose and frequency than recommended, pseudomembranous OC was noted on the buccal and soft palate mucosae at the follow-up appointment two weeks later. The patient was prescribed an oral suspension of nystatin (100,000 IU) for gargling four times a day, and complete resolution of the OC was achieved within a period of 14 days. Subsequently, the OLP lesions reverted to a reticular form with appropriate use of the topical steroid. The patient remains under regular follow-up at our clinic. Secondary OC may obscure and/or aggravate the clinical features and symptoms of OLP, potentially hindering effective management. Close monitoring of pharmacological therapy and early intervention for secondary OC are vital in achieving optimal treatment outcomes.

Keywords

• adverse effect
• oral lichen planus
• secondary oral candidiasis
• topical corticosteroid

References

1. Al-Hashimi I, Schifter M, Lockhart PB, et al. Oral lichen planus and oral lichenoid lesions: diagnostic and therapeutic considerations. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;103 Suppl:S25.e1-12.
2. Farhi D, Dupin N. Pathophysiology, etiologic factors, and clinical management of oral lichen planus, part I: facts and controversies. Clin Dermatol. 2010;28(1):100-8.
3. Carrozzo M, Porter S, Mercadante V, Fedele S. Oral lichen planus: A disease or a spectrum of tissue reactions? Types, causes, diagnostic algorhythms, prognosis, management strategies. Periodontol 2000. 2019;80(1):105-25.
4. Rodriguez-Archilla A, Fernandez-Torralbo S. Candida species colonization in oral lichen planus: A meta-analysis. Int J Health Sci (Qassim). 2022;16(4):58-63.
5. Ismail SB, Kumar SK, Zain RB. Oral lichen planus and lichenoid reactions: etiopathogenesis, diagnosis, management and malignant transformation. J Oral Sci. 2007;49(2):89-106.
6. Li C, Tang X, Zheng X, et al. Global prevalence and incidence estimates of oral lichen planus: a systematic review and metaanalysis. JAMA Dermatol. 2020;156(2):172- 81.
7. Scully C, Carrozzo M. Oral mucosal disease: Lichen planus. Br J Oral Maxillofac Surg. 2008;46(1):15-21.
8. Parlatescu I, Nicolae C, Tovaru S, Radu L, Penes O, Varlas V. The implication of candida infection in oral lichen planus lesions. Maedica (Bucur). 2021;16(4):585-9.

9. DeRossi SS, Ciarrocca KN. Lichen planus, lichenoid drug reactions, and lichenoid mucositis. Dent Clin North Am. 2005;49(1):77-89, viii.
10. Thongprasom K, Luengvisut P, Wongwatanakij A, Boonjatturus C. Clinical evaluation in treatment of oral lichen planus with topical fluocinolone acetonide: a 2-year follow-up. J Oral Pathol Med. 2003;32(6):315-22.
11. Rotaru D, Chisnoiu R, Picos AM, Picos A, Chisnoiu A. Treatment trends in oral lichen planus and oral lichenoid lesions (Review). Exp Ther Med. 2020;20(6):198.
12. Carbone M, Goss E, Carrozzo M, et al. Systemic and topical corticosteroid treatment of oral lichen planus: a comparative study with long-term follow-up. J Oral Pathol Med. 2003;32(6):323-9.
13. Muzyka BC, Glick M. A review of oral fungal infections and appropriate therapy. J Am Dent Assoc. 1995;126(1):63-72.
14. Jainkittivong A, Kuvatanasuchati J, Pipattanagovit P, Sinheng W. Candida in oral lichen planus patients undergoing topical steroid therapy. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;104(1):61- 6.
15. Patil S, Rao RS, Majumdar B, Anil S. Clinical appearance of oral candida infection and therapeutic strategies. Front Microbiol. 2015;6:1391.
16. Lombardi A, Ouanounou A. Fungal infections in dentistry: clinical presentations, diagnosis, and treatment alternatives. Oral Surg Oral Med Oral Pathol Oral Radiol. 2020;130(5):533-46.
17. Saepoo J, Kerdpon D, Pangsomboon K. Prevalence of and prognostic factors for Candida superinfection in oral lichen planus and lichenoid reactions: a retrospective cohort study. J Oral Pathol Med. 2023;52(5):440-7.
18. Thongprasom K, Dhanuthai K. Steroids in the treatment of lichen planus: a review. J Oral Sci. 2008;50(4):377-85.
19. Xue JL, Fan MW, Wang SZ, Chen XM, Li Y, Wang L. A clinical study of 674 patients with oral lichen planus in China. J Oral Pathol Med. 2005;34(8):467-72.
20. Aguirre JM, Bagán JV, Rodriguez C, et al. Efficacy of mometasone furoate microemulsion in the treatment of erosiveulcerative oral lichen planus: pilot study. J Oral Pathol Med. 2004;33(7):381-5.
21. Lundström IM, Anneroth GB, Holmberg K. Candida in patients with oral lichen planus. Int J Oral Surg. 1984;13(3):226-38.
22. Gumru Tarcin B. Oral candidosis: aetiology, clinical manifestations, diagnosis and management. MÜSBED. 2011;1(2):140-8.
23. Kragelund C, Kieffer-Kristensen L, Reibel J, Bennett EP. Oral candidosis in lichen planus: the diagnostic approach is of major therapeutic importance. Clin Oral Investig. 2013;17(3):957-65.
24. Zeng X, Hou X, Wang Z, Jiang L, Xiong C, Zhou M, Chen Q. Carriage rate and virulence attributes of oral Candida albicans isolates from patients with oral lichen planus: a study in an ethnic Chinese cohort. Mycoses. 2009;52(2):161-5.
25. Marable DR, Bowers LM, Stout TL, et al. Oral candidiasis following steroid therapy for oral lichen planus. Oral Dis. 2016;22(2):140- 7.
26. Arora S, Verma M, Gupta SR, Urs AB, Dhakad MS, Kaur R. Phenotypic variability and therapeutic implications of Candida species in patients with oral lichen planus. Biotech Histochem. 2016;91(4):237-41.
27. Gainza-Cirauqui ML, Nieminen MT, Novak Frazer L, Aguirre-Urizar JM, Moragues MD, Rautemaa R. Production of carcinogenic acetaldehyde by Candida albicans from patients with potentially malignant oral mucosal disorders. J Oral Pathol Med. 2013;42(3):243-9.
28. Marttila E, Bowyer P, Sanglard D, et al. Fermentative 2-carbon metabolism produces carcinogenic levels of acetaldehyde in Candida albicans. Mol Oral Microbiol. 2013;28(4):281-91.
29. Bombeccari GP, Giannì AB, Spadari F. Oral Candida colonization and oral lichen planus. Oral Dis. 2017;23(7):1009-10.