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Dermatology (Expert Forum)
Follow Up/Advice on Fungal Infection
Answered by
Alan Rockoff, MD - dermatology, Child Skin Problems
The Rockoff Dermatology Center
Brookline - MA
Welcome to the DERMATOLOGY FORUM! Questions in this forum are answered by Dermatologists from St. Luke's Roosevelt Hospital, under the direction of Andrew Alexis, M.D., M.P.H.
Follow Up/Advice on Fungal Infection
by 345medhelpFAN, Jan 25, 2006 12:00AM
28 year old male, HIV negative, normal bloodwork as of early Dec.
About mid-Dec I felt some irritation on the insides of my cheeks in my mouth. It appeared to be skin sloughing, when I brush away the skin, there was some mild bleeding. I also had little bits of white stuff, maybe skin around my mouth that where loose. I went to the Dentist and he felt it was just irritation, likely from Listerine use, maybe too much Listerine use. I stopped using it, and irritation seemed to back off a bit. About a week post-Listerine I started to get some other symptoms. Taste changes/metallic taste, dry mouth, some burning sensations, and a little bit of discomfort when I would swallow, but nothing I would call pain.
At two week follow up the dentist said my mouth looked better, I explained to him my other systems, he felt things were moving in the right direction since my mouth irritation improved. In between visits I had done some research and mentioned to my dentist that my symptoms seem inline wth Oral Lichen Planus because I had also noticed some bilateral white lines on my cheeks. He sort of agreed and he offered up Dexadron mouth rinse (steroid) to speed things up.
I used the mouth rinse and i felt the irritation improved, but no improvement in dry mouth, no more metallic taste or burning sensation, still a little bit of difficulty swallowing. The dexadron was for 5 days but around day 7 I felt difficulty swallowing becoming more noticable again, dry mouth more noticable, and day 9 I felt a mild reoccurance of some irritation.
Then I was with my friend who is a Physican's Assistant and she said all my symptoms sound like Oral Thrush, triggered by maybe overuse of Antiseptic mouthwash (listerine). She advised to return to the dentist. He said my mouth looked better and he gave my Nystatin for thrush, said it wouldn't hurt to try.
I have been on Nystatin mouth solution now, day 8 of 12. My reoccurance of mouth irritation cleared up after 3 days of Nystatin. Right now I am still getting dry mouth a few times a day and swallowing difficulty seems to wax and wane, Sunday I felt it was almost back to normal, now I feel a little tightness swallowing...improvement is just not clear.
Oral Thrush seems like it makes the most sense. I wanted to get your take on all of this. As of right now I think I might be improving, but its not very clear, I don't think I am getting any worse.
Would you recommend anything...an oral anti fungal tablet? Do you think I am not the right path?
thanks.
About mid-Dec I felt some irritation on the insides of my cheeks in my mouth. It appeared to be skin sloughing, when I brush away the skin, there was some mild bleeding. I also had little bits of white stuff, maybe skin around my mouth that where loose. I went to the Dentist and he felt it was just irritation, likely from Listerine use, maybe too much Listerine use. I stopped using it, and irritation seemed to back off a bit. About a week post-Listerine I started to get some other symptoms. Taste changes/metallic taste, dry mouth, some burning sensations, and a little bit of discomfort when I would swallow, but nothing I would call pain.
At two week follow up the dentist said my mouth looked better, I explained to him my other systems, he felt things were moving in the right direction since my mouth irritation improved. In between visits I had done some research and mentioned to my dentist that my symptoms seem inline wth Oral Lichen Planus because I had also noticed some bilateral white lines on my cheeks. He sort of agreed and he offered up Dexadron mouth rinse (steroid) to speed things up.
I used the mouth rinse and i felt the irritation improved, but no improvement in dry mouth, no more metallic taste or burning sensation, still a little bit of difficulty swallowing. The dexadron was for 5 days but around day 7 I felt difficulty swallowing becoming more noticable again, dry mouth more noticable, and day 9 I felt a mild reoccurance of some irritation.
Then I was with my friend who is a Physican's Assistant and she said all my symptoms sound like Oral Thrush, triggered by maybe overuse of Antiseptic mouthwash (listerine). She advised to return to the dentist. He said my mouth looked better and he gave my Nystatin for thrush, said it wouldn't hurt to try.
I have been on Nystatin mouth solution now, day 8 of 12. My reoccurance of mouth irritation cleared up after 3 days of Nystatin. Right now I am still getting dry mouth a few times a day and swallowing difficulty seems to wax and wane, Sunday I felt it was almost back to normal, now I feel a little tightness swallowing...improvement is just not clear.
Oral Thrush seems like it makes the most sense. I wanted to get your take on all of this. As of right now I think I might be improving, but its not very clear, I don't think I am getting any worse.
Would you recommend anything...an oral anti fungal tablet? Do you think I am not the right path?
thanks.
Doctor's Answer
by Alan Rockoff, MD, Jan 26, 2006 12:00AM
, Jan 26, 2006 12:00AM
To be honest, your description leaves me wondering whether you have anything at all. Even if it was thrush (yeast), the Nystatin would have cleared it up, which means that the "dry mouth a few times a day and swallowing difficulty" are almost certainly caused by anxiety.
Rather than let your symptoms lead you to suggest diagnoses to your doctors, who then "sort of" agree, since this matter is making you concerned, I advise you to consult a specialist in oral medicine. Perhaps your local medical center has one. Meantime, avoid using any medicated products, and if you can, ignore the symptoms until you are examined.
Best.
Dr. Rockoff
Rather than let your symptoms lead you to suggest diagnoses to your doctors, who then "sort of" agree, since this matter is making you concerned, I advise you to consult a specialist in oral medicine. Perhaps your local medical center has one. Meantime, avoid using any medicated products, and if you can, ignore the symptoms until you are examined.
Best.
Dr. Rockoff
One common reason that i find for the occurence of oral thrush in my otherwise normal (non-immunocompromised) patients is the use of a steroid asthma inhaler without using a spacer. Also rinsing after using such an inhaler is advisable.
Denture wearers are also susceptible as well as those who have completed a recent course of antibiotics.
It is true that listerine like antibiotics may kill off competing flora in your mouth and thus provide an oppotunity for fungal overgrowth. But unfortunately this theory is unlikely since listerine is quite effective in killing fungi and has many off-label uses for this reason.
Your thrush can predispose you for a decending infection such as candidial esophagitis which may be responsible for your painful swallowing. I would continue to take your nystatin as prescribed. If your swallowing continues to get worse your doctor may start you on a course of a systemic antifungal such as fluconazole.