Candida (Skin & Oral) 🍄
HSE AMRIC guideline for cutaneous and oral Candida infection: interactive treatment guide by presentation and age, self-care, and when to refer.
Candida treatment guide
Select presentation and age — HSE AMRIC skin & oral guideline
Presentation
Patient age
Recurrent disease? (adults — systemic options)
Recommended regimens
First-line oropharyngeal therapy (not recurrent)
Adult — oropharyngeal regimens below. Systemic options apply to adults with recurrent disease only.
Oropharyngeal — 1st choice
- Miconazole gel should not be swallowed immediately, but kept in the mouth as long as possible. Divide into pea-sized portions; smear in the mouth after feeds with a clean finger — no clumps of gel.
- For oral candidosis, dental prostheses should be removed at night and brushed with the gel.
- Miconazole — check for drug interactions.
- Nystatin: keep suspension in contact with oral mucosa for as long as possible before swallowing or spitting out. Larger volumes may be needed for extensive infection.
- Nystatin: usually 7 days — continue 48 hours after clinical cure; re-evaluate if signs and symptoms persist beyond 14 days.
Miconazole 20 mg/mL oral gel
- Dose:
- 2.5 mL (half of measuring spoon provided) four times daily after meals
- Duration:
- Continue for at least a week after symptoms have disappeared.
Adults and children ≥2 years (HSE).
Nystatin 100,000 units/mL oral suspension
- Dose:
- 1–6 mL every 6 hours after meals
- Duration:
- Usually 7 days; continue 48 h after clinical cure; re-evaluate if >14 days.
Adult and children >2 years (HSE).
📖 Scope
- This guideline covers antifungal treatment for cutaneous and oral Candida infection.
- For genital thrush (male and female) — refer to Candida, genital thrush in the genital guidelines.
- For nipple thrush — refer to nipple and breast thrush in pregnancy and postpartum guidelines.
- For angular cheilitis — refer to angular cheilitis in dental guidelines.
- Systemic Candida infection, Candida infection of the ear canal, and oesophageal candidiasis are outside the scope of this guideline.
- Oesophageal candidiasis can be associated with immunocompromise including HIV infection and requires further investigation and referral to an appropriate specialist.
🧠 Diagnosis & general advice (Expert Advisory Group)
- Diagnosis is generally made on clinical grounds.
- In case of treatment failure, it may be necessary to send samples for fungal culture.
- Review modifiable risk factors in case of recurrence and refractory disease.
🧭 Clinical workflow
- 1. Confirm scope — cutaneous and/or oropharyngeal candidiasis only; refer if outside scope (see above).
- 2. Treatment guide — use the interactive tool above: select presentation, age band, and recurrence (adults) for first-line and systemic regimens from the HSE AMRIC guideline.
- 3. Self-care & risk factors — address modifiable factors and counsel on hygiene (see below).
- 4. Refer if recurrent cutaneous or oropharyngeal disease, treatment failure, or concern for underlying immunocompromise.
🏠 General advice for self-care
- Cutaneous candidiasis — self-management: Candidiasis is particularly likely to affect flexures in warm weather especially in those living with obesity. Keeping these areas dry, particularly skin folds, can help prevent recurrence.
- Oral candidiasis — self-management: Practice good oral hygiene; brush teeth regularly; use warm saline water as a mouth wash; avoid use/overuse of antiseptic mouthwashes, as they alter the flora of the mouth; rinse mouth out with water after using a steroid inhaler; smoking is a risk factor for oral candidiasis and smoking cessation should be considered.
- Denture wearers: clean dentures with an anti-candidal preparation, such as 1% sodium hypochlorite solution; remove dentures overnight.