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Diagnosing Erythematous Candidiasis
Jun 23, 1999

Dr. Reznik, How difficult is it to diagnose erythematous candidiasis? Starting last November, I developed these flat red patches on my tounge (mainly the tip). In the morning, they usually have a faint white outline that goes away after I eat or brush my teeth. They look like the pictures you've got posted of erythematous candidiasis. They started about the same time I experienced a viral syndrome consistent with HIV. However, I tested negative for HIV at 3, 5, and 7 months post-exposure. My GP has looked at my tounge twice and my dentist once. Both say "yeah, the end of your tounge looks red" and my doctor told me to take Lactinex tablets (which have provided some relief, but not gotten rid of it). He also said I had a little bit of a geographic tounge, but I don't think it looks like the pictures of geographic tounge that I've seen. I've also got a slight burning sensation with it. I've had this sometimes in the past when I've been sick, but it's always resolved within a few days. What are the chances that both my doctor and dentist misdiagnosed this? I'm assuming the chances are low, and that if it was erythematous candidiasis, they'd try to do something about it. Is this usually diagnosed just by a visual inspection?

Response from Dr. Reznik

Erythematous candidiasis is diagnosed by appearance taking into consideration the patient's underlying medical condition or medications they may be on. It is possible to perform a lab test (KOH stain) to confirm the diagnosis, but the results will be different from what one would see with pseudomembranous candidiasis as there would only be a few hyphae present.

Whereas it is possible to see erythematous candidiasis anywhere within the oral cavity, it does tend to appear on the dorsal surface of the tongue, usually in the middle, or on the hard and soft palates. Erythematous candidiasis is not associated with white borders.

Geographic tongue is associated with white borders and can appear anywhere on the tongue, including the tip of the tongue. Geographic tongue may clear up without intervention, but the erythematous form of candidiasis in patients that are immunocompromised normally would require a topical antifungal agent, such as Mycelex troches, to clear up this condition.

I hope this information proves helpful.

DR


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