Oral Candidiasis in Patients With Oral Lichen Planus Receiving Topical Corticosteroids: A Retrospective Cohort Study

To estimate the incidence and predictors of oral candidiasis in patients with oral lichen planus (OLP) treated with topical corticosteroids.

Retrospective cohort study of 312 adults with OLP followed for 487.5 person-years. The primary outcome was the first microbiologically confirmed episode of oral candidiasis. Adjusted incidence rate ratios (IRRs and rinses) were estimated using Poisson regression; Cox proportional hazards models were used for sensitivity analysis.

Oral candidiasis occurred in 78 patients (25.0%; incidence rate 0.160 per person-year), with a median onset of 4 months. Risk peaked within the first 2 months and declined thereafter (IRR = 0.33 for 4-8 months; IRR = 0.08 for > 8 months). Higher disease severity predicted infection (highest vs. lowest quartile: IRR = 1.61; 95% CI: 1.02-2.54). Poor oral hygiene (IRR = 1.88; 95% CI: 1.13-3.13) and removable partial dentures (IRR = 1.68; 95% CI: 1.07-2.63) were independently associated. Clobetasol propionate showed a higher risk than triamcinolone acetonide (IRR = 1.48; 95% CI: 0.96-2.28); these associations remained consistent in sensitivity analysis. No associations were observed for age, sex, alcohol use or xerostomia.

Oral candidiasis is common in corticosteroid-treated OLP. Risk is driven by disease severity and modifiable local factors, supporting targeted prevention and monitoring.