Saepoo Jirayu, Kerdpon Duangporn, Pangsomboon Kanokporn
Section of Oral Medicine, Department of Oral Diagnostic Sciences, Faculty of Dentistry, Prince of Songkla University, Hatyai, Songkhla, Thailand.
J Oral Pathol Med. 2023 May;52(5):440-447. doi: 10.1111/jop.13420. Epub 2023 Mar 28.
Oral candidiasis occasionally occurs in patients with oral lichen planus (OLP) or lichenoid reaction (OLR). However, not all patients undergoing corticosteroid therapy develop Candida superinfection. Thus, the identification of prognostic risk factors may help to identify patients at risk of Candida superinfection.
A retrospective cohort study was conducted to review patients with OLP/OLR who received steroid therapy at a single dental hospital between January 2016 and December 2021. The prevalence of Candida superinfection and prognostic factors were assessed.
Eighty-two eligible patients with OLP/OLR were retrospectively reviewed. The overall prevalence of Candida superinfection during the study period was 35.37%; the median time-to-event between initiation of corticosteroid therapy and diagnosis of superinfection was 60 days (interquartile range; 34-296). The ulcerative type of OLP/OLR, number of topical steroid applications, poor oral hygiene, and oral dryness were significantly associated with superinfection (p < 0.05; Fisher's Exact test) and were identified as prognostic factors in univariable risk ratio regression. Multivariable risk ratio regression revealed the ulcerative type of OLP/OLR and number of topical steroid applications were significant prognostic factors for Candida superinfection in patients with OLP/OLR.
Candida superinfection occurs in approximately one-third of patients with OLP/OLR undergoing corticosteroid therapy. Patients with OLP/OLR should be closely monitored in the first 2 months (60 days; median time to infection) after steroid prescription. The ulcerative type of OLP/OLR and a higher number of topical steroid applications per day may represent prognostic factors to identify patients at risk of Candida superinfection.
口腔念珠菌病偶尔会发生在口腔扁平苔藓（OLP）或苔藓样反应（OLR）患者中。然而，并非所有接受皮质类固醇治疗的患者都会发生念珠菌二重感染。因此，识别预后风险因素可能有助于确定有念珠菌二重感染风险的患者。
进行了一项回顾性队列研究，以回顾2016年1月至2021年12月期间在一家牙科医院接受类固醇治疗的OLP/OLR患者。评估念珠菌二重感染的患病率和预后因素。
对82例符合条件的OLP/OLR患者进行了回顾性分析。研究期间念珠菌二重感染的总体患病率为35.37%；从开始皮质类固醇治疗到诊断为二重感染的事件发生时间中位数为60天（四分位间距；34 - 296天）。OLP/OLR的溃疡型、局部类固醇应用次数、口腔卫生差和口腔干燥与二重感染显著相关（p < 0.05；Fisher精确检验），并在单变量风险比回归中被确定为预后因素。多变量风险比回归显示，OLP/OLR的溃疡型和局部类固醇应用次数是OLP/OLR患者念珠菌二重感染的重要预后因素。
接受皮质类固醇治疗的OLP/OLR患者中约三分之一会发生念珠菌二重感染。OLP/OLR患者在开具类固醇处方后的前2个月（60天；感染的中位时间）应密切监测。OLP/OLR的溃疡型和每天较高的局部类固醇应用次数可能是识别有念珠菌二重感染风险患者的预后因素。
