Hyperplastic candidiasis (HC), a chronic infection of the oral mucosa, is caused by Candida. Its potential for malignant transformation demands early intervention. Conventional surgical resection might cause irreversible damage and impact the patients quality of life. Hence, the present study evaluated the efficacy of 5-aminolevulinic acid (5-ALA)-mediated photodynamic therapy (PDT) alone and with topical antifungal therapy (i.e., nystatin [combination therapy]) and contrasted them with nystatin and surgical resection for treating HC.

The study enrolled 40 subjects with clinical and histopathological diagnoses of HC and divided them into four study groups, with 10 participants each. Group I received an antifungal agent (nystatin); Group II received surgical resection; Group III received PDT and Group IV received 5-ALA-mediated PDT and nystatin (combination therapy). It collected salivary and mucosal samples to quantify Candida albicans and recorded the treatment responses to different interventions at Week 4, Week 6 and Week 8 after finishing therapies.

The study observed:

• Complete improvement in 30%, 20%, 10% and 50% of patients in Group I, Group II, Group III and Group IV, respectively, at the 3rd follow-up (i.e., at the end of the 8th week after the interventions).
• A statistically significant difference in comparing the intervention responses in Group I, Group II and Group IV subjects, at Week 4, Week 6 and Week 8 follow-ups.
• Lowest colony-forming units/milliliter score of C. albicans in Group IV subjects at the 8-week follow-up.

This study shows that the application of 5-ALA-mediated PDT along with nystatin gel is a well-tolerated and safe therapeutic modality for treating patients with HC.

Source: AlGhamdi AS, Qamar Z, AlSheikh R, et al. Clinical efficacy of 5-aminolevulinic acid-mediated photodynamic therapy versus topical antifungal agent and surgical excision for the treatment of hyperplastic candidiasis. Photodiagnosis Photodyn Ther. 2023;41:103258.