Biopsy of an oral lesion demonstrates fungal HYPHAE within the epithelium. What is the appropriate treatment?

Correct answer: B. Fluconazole (or another antifungal agent)

• A. NSAIDs address pain only and leave the infection untreated.
• B. CORRECT. HYPHAE (and pseudohyphae) on histology or a PAS stain indicate CANDIDA. Treatment is antifungal — topical (nystatin, clotrimazole troches) for mild localised disease, or systemic FLUCONAZOLE for extensive, recurrent, or immunocompromised cases. Underlying contributors (denture wear, xerostomia, inhaled steroids, uncontrolled diabetes, HIV) must be addressed at the same time.
• C. Clobetasol is a high-potency topical CORTICOSTEROID. Applying a steroid to a fungal infection suppresses local immunity and makes the candidiasis worse. It treats lichen planus, not candidiasis.
• D. Antibiotics have no activity against fungi and in fact predispose to candidiasis by suppressing competing bacterial flora.

Note: Hyphae = fungal = antifungal. Flag for the group.