Oral Liken Planusta Kandidiazis: Aşırı Topikal Kortikosteroid Kullanımına Bağlı Komplikasyon

Öz

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.

Anahtar Kelimeler

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

Candidiasis in Oral Lichen Planus: Complication of Topical Corticosteroid Overuse

Öz

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.

Anahtar Kelimeler

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

Kaynakça

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