Clinician's Guide Pharmacology in Dental Medicine

Caution: Ketaconazole and fluconazole are potent inhibitors of the hepatic microsomal enzyme system CYP3A4. As such, drug interactions must be anticipated in patients concurrently taking anticoagulant, antihistamine, antianxiety, and cholesterol-lowering medications. If patients fail to respond to systemic therapy, they should be referred to an infectious disease specialist for evaluation of resistant strains or the diagnosis must be reevaluated

These medications (caspofungin, micafungin, anidulafungin) are not currently recommended

Nystatin with triamcinolone acetonide or clotrimazole with betamethasone dipropionate preparations are quite useful for this purpose. Patients should be encouraged not to lick the lesions because this will serve to further superinfect the cheilosis with salivary bacteria. If the combination of medications is not readily available, the patient can be prescribed the two creams and mix a small amount of each in the palm of the hand before applying to the area.
In cases of refractory or mucocutaneous candidosis, patients in whom compliance is a problem, or women who have a concurrent candidal vaginitis, systemic antifungal therapy with ketaconazole or fluconazole is recommended. If either of these medications is used for longer than 2 weeks, liver function tests should be performed to monitor potential hepatotoxicity. A new class of antifungal medications known as echinocandins is available to treat resistant fungal infections