Chronic Mucocutaneous Candidiasis Treatment & Management
- Author: Neil Sandhu, MD; Chief Editor: Dirk M Elston, MD more...
Management can be difficult, and relapse is common following discontinuation of therapy. Topical therapies are not usually effective in patients with CMC. Treatment of oral involvement in CMC can be aided by therapy with clotrimazole troches or oral nystatin solution. Treatment falls into 3 main categories: antifungal agents, immunologic therapies, and combination therapy.
Systemic antifungal therapy is the mainstay of CMC therapy. It may be used alone or in combination with an immunomodulatory agent. The drawbacks of systemic antifungal therapy include the risk of adverse effects or toxicity, a failure to correct the underlying immune deficiency, relapse following the cessation of therapy, and antifungal resistance to some antifungal agents.
Several immunologic therapies have been proposed in an effort to correct the underlying immune deficiency in persons with CMC. The most widely studied treatment is the use of transfer factor. Transfer factor is a cell-free protein extracted from the T lymphocytes of Candida-immune donors. Although the precise mechanism is unknown, it has been shown to transfer delayed-type hypersensitivity reactions to patients previously anergic to candidal skin testing. Candida-specific cell immunity may be transferred by this approach. It is not effective in all cases. Long-term remissions have occurred when combined with antifungal medications.
Refer patients to an endocrinologist if screening laboratory test results suggest an associated endocrine abnormality.
If familial CMC is suspected, consultation with a geneticist should be obtained.
Patients with recurrent infections or pneumonia should be referred to an immunologist.
Baseline studies and yearly screening for associated endocrinopathy should be performed. Long-term follow-up is necessary for identifying and addressing accompanying disorders.
Some authors suggest screening angio-MRI for all patients with diagnosed CMC to rule out aneurysm; but this is not a universal recommendation.
If the disease flares, patients may need to be seen on an urgent basis, particularly after a course of antifungals has been discontinued.
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