pH. by interactions with other drugs such as rifampicin, acyclovir, cyclosporine. phenytoin. H2-antagonists, terfenadine. astemizole. or by the emergence of resistant or less susceptible strains of Candida.
Clinicians should avoid systemic azoles in patients with severe liver disease and during pregnancy. The most frequent side effects of itraconazole and fluconazole are gastrointestinal symptoms (nausea, vomiting, diarrhea, epigastralgia)and rash.
Topical Treatment
Nystatin oral suspension four times a day or miconazole oral gel 5 ml four times a day for 1-2 weeks is indicated, particularly for oral acute pseudomembranous candidiasis in infants or children or for adults where systemic treatment is not indicated. Angular cheilitis (perlèche) is treated with topical antifungal ointments.
Future Therapies
Third generation triazoles (voriconazole, posa-conazole. ravuconazole), echinocandins (main representative caspofungin) and the incorporation of nystatin into liposomes are being investigated as possible alternative treatments.
References
Davies A, Brailsford S, Broaclley K, Beighlon D. Resistance amongst yeasts isolated from the oral cavities of patients with advanced cancer. Patiiat Med 2002;16:527–531.
Dismukes WE. Introduction to antifungal drugs. Clin Infect Dis 2000;30:653–657.
Ellepola ANB, Samaranayake LP. Antimycotic agents in oral candidosis: An overview: 2. Treatment of oral candidosis. Dent Update 2000;27;165–174.
Epstein JB, Gorsky M, Caldwell J. Fluconazole mouthrinses for oral candidiasis in postirradiation, transplant, and other patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;93:671–675.
Fratti KA, Belanger PH, Samari H. The effect of the new triazole, voriconazole (UK-109, 496) on the interactions of Candida albicans and Candida krusei with endothelial cells. J Chemother 1998;10:7–16.
Goins RA, Ascher D, Waecker N, et al. Comparison of fluconazole and nystatin oral suspensions for treatment of oral candidiasis in infants. Pediatr Infect Dis J 2002;21:1165–1167.
Groll AH, Wood L, Roden M, et al. Safety, pharmacokinetics, and pharmacodynamics of cyclodextrin itraconazole in pediatric patients with oropharyngeal candidiasis. Antimicrob Agents Chemother 2002;46:2554–2563.
Johnson LB, Kauffman CA. Voriconazole: A new triazole antifungal agent. Clin Infect Dis 2003;36:630–637.
Koks CHW, Meenhorst PL, Bull A, Beijnen JH. Itraconazole solution: Summary of pharmacokinetic features and review of activity in the treatment of fluconazole-resistant oral candidiasis in HIV-infected persons. Pharmacol Res 2002;46:195–201.
Koltin Y, Hitchock CA. Progress in the search for new triazole antifungal agents. Curr Opin Chem Biol 1997;1:176–182.
Tacconelli E, Bertagnolio S, Posteraro B, et al. Azole susceptibility patterns and genetic relationship among oral Candida strains isolated in the era of highly active antiretroviral therapy. J Acquit Immune Defic Syndr 2002;31:38–44.
Terrell CL. Antifungal agents. Part II. The azoles. Mayo Clin Proc 1999;74:78–100.
Villanueva A, Gotuzzo E, Arathoon EG, et al. A randomized double-blind study of caspofungin versus fluconazole for the treatment of esophageal candidiasis. Am J Med 2002;113:294–299.
Worthington HV, Clarkson JE, Prevention of oral mycositis and oral candidiasis for patients with cancer treated with chemotherapy: Cochrane systematic review. J Dent Educ 2002;66:903–911.
Cheilitis Glandularis
Cheilitis glandularis is a rare chronic inflammatory disorder of the lower lip characterized by hyperplasia of the minor salivary glands.
The etiology of cheilitis glandularis is unknown.
•Lip enlargement
•Typically, the orifices of the secretory ducts become dilatated and appear as numerous pinhead openings from which mucus or mucopurulent secretion may be expressed on pressure
•Crusting, erosions, and microabscesses may occur
•Characteristically, the lesions are limited to the lower lip
The clinical diagnosis should be confirmed by a biopsy and histopathologic examination.
•Cheilitis granulomatosa
•Melkersson-Rosenthal syndrome
•Crohn disease
•Orofacial granulomatosis
•Sarcoidosis
•Tuberculosis
•Lymphedema
•Lymphangioma
Basic Guidelines
•There is no causative treatment.
•The treatment is palliative.
Suggested Therapies
•Topical ointment or intralesional injection of corticosteroids may offer temporary and limited improvement.
•Systemic oral corticosteroids, e.g., prednisone 20-30 mg/day for 2-3 weeks, followed by tapering and stopping the drug in a month’s time has also limited value as the disease recurs.
•Systemic antibiotics, e.g., minocycline 100-200 mg/day for 2-4 weeks, may temporarily improve the condition, particularly if an infection is present.
•Plastic surgery (vermilionectomy) for reconstruction of an enlarged lip is necessary for advanced severe cases.
References
Cohen DM, Green JG, Diekmann SL. Concurrent anomalies: Cheilitis glandularis and double lip: report of a case. Oral Surg Oral Med Oral Pathol 1988;66:397–399.
Leao JC, Feneira AM, Martins S, et al. Cheilitis glandularis: An unusual presentation in a patient with HIV infection. Oral Surg Oral Med Oral Pathol Oral
