Clinical efficacy of 5-aminolevulinic acid-mediated photodynamic therapy versus topical antifungal agent and surgical excision for the treatment of hyperplastic candidiasis

AbdulRahman Saeed AlGhamdi; Zeeshan Qamar; Rasha AlSheikh; Muntasar Talib Ali Al Hinai; Nishath Sayed Abdul; Eman Ahmed Aljoghaiman; Saqib Ali

doi:10.1016/j.pdpdt.2022.103258

Clinical efficacy of 5-aminolevulinic acid-mediated photodynamic therapy versus topical antifungal agent and surgical excision for the treatment of hyperplastic candidiasis

Photodiagnosis Photodyn Ther. 2023 Mar:41:103258. doi: 10.1016/j.pdpdt.2022.103258. Epub 2022 Dec 30.

Authors

AbdulRahman Saeed AlGhamdi¹, Zeeshan Qamar², Rasha AlSheikh³, Muntasar Talib Ali Al Hinai⁴, Nishath Sayed Abdul⁵, Eman Ahmed Aljoghaiman⁶, Saqib Ali⁷

Affiliations

¹ Department of Restorative and Prosthetic Dentistry, College of Dentistry, Dar Al Uloom University, Riyadh, Saudi Arabia. Electronic address: abdrh.alghamdi@dau.edu.sa.
² Department of O&MFS and Diagnostic Sciences, Faculty of Dentistry, Riyadh Elm University, Riyadh, Saudi Arabia.
³ Department of Restorative Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam, Saudi Arabia.
⁴ Dental and Maxillofacial Surgery Department, Sultan Qaboos University Hospital Sultan Qaboos University, Muscat Oman.
⁵ Department of OMFS and Diagnostic Sciences (Oral Pathology), Faculty of Dentistry, Riyadh Elm University, Riyadh, Saudi Arabia.
⁶ Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam, Saudi Arabia.
⁷ Department of Biomedical Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam, Saudi Arabia.

PMID: 36592782
DOI: 10.1016/j.pdpdt.2022.103258

Abstract

Background: Hyperplastic candidiasis (HC) is a chronic infection of oral mucosa caused by Candida. Owing to its potential for malignant transformation, its intervention requires attention. Conventional surgical resection might lead to irreversible damage and impact the patient's quality of life. Hence, this study aimed to evaluate the clinical efficacy of 5-aminolevulinic acid (5-ALA)-mediated photodynamic therapy (PDT) alone and in combination with topical antifungal therapy (i.e., nystatin [combination therapy]) in comparison with nystatin and surgical resection for the treatment of HC.

Methods: Forty subjects with clinical and histopathological diagnoses of HC were included in the study. Four study groups, with 10 participants each, were formed as follows: Group-I - receiving antifungal agent [nystatin]; Group-II - receiving surgical resection; Group-III - receiving PDT; and Group-IV - receiving 5-ALA-mediated PDT and nystatin [combination therapy]. Salivary and mucosal samples were collected for the quantification of Candida albicans and the treatment responses to different interventions were recorded at week-4, week-6, and week-8 after finishing therapies.

Results: At the 3^rd follow-up (i.e., at end of the 8^th week after the interventions), complete improvement in 3 (30%), 2 (20%), 1 (10%), and 5 (50%) patients in group-I, group-II, group-III, and group-IV, respectively was observed. A statistically significant difference was obtained when the intervention responses were compared at week-4 (p<0.01), week-6 (p<0.01), and week-8 (p<0.0001) follow-ups in group-I, group-II, and group-IV subjects. At the 8-week follow-up regarding the salivary and mucosal samples, the lowest colony-forming units/milliliter score of C. albicans was observed in group-IV subjects.

Conclusion: The application of 5-ALA-mediated PDT in combination with nystatin gel possesses the potential as a well-tolerated and safe therapeutic modality for the treatment of patients with HC.

Keywords: Aminolevulinic acid; Antifungal agents; Oral candidiasis; Photodynamic Therapy; Photosensitizing agents.

MeSH terms

Aminolevulinic Acid / therapeutic use
Antifungal Agents / therapeutic use
Candida albicans
Candidiasis, Oral* / drug therapy
Humans
Nystatin / therapeutic use
Photochemotherapy* / methods
Photosensitizing Agents / therapeutic use
Quality of Life
Treatment Outcome

Substances

Aminolevulinic Acid
Antifungal Agents
Nystatin
Photosensitizing Agents