Chronic hyperplastic candidiasis (CHC) includes a variety of clinically recognized conditions in which mycelial invasion of the deeper layers of the mucosa and skin occurs, causing a proliferative response of host tissue (Figure 5-20).
Candidal leukoplakia is considered a chronic form of oral candidiasis in which firm white leathery plaques are detected on the cheeks, lips, palate, and tongue (Figure 5-21). The differentiation of candidal leukoplakia from other forms of leukoplakia is based on finding periodic acid–Schiff (PAS)–positive hyphae in leukoplakic lesions. CHC also occurs as part of chronic mucocutaneous candidiasis, often with identifiable predisposing immunologic or endocrine abnormalities. These patients develop similar lesions around the nails and other skin sites or alternatively develop only isolated oral lesions. CHC also occurs on the dorsum of the tongue and may resemble median rhomboid glossitis (Figure 5-22).
Approximately 10% of oral leukoplakias satisfy the clinical and histologic criteria for CHC.Epithelial dysplasia occurs four to five times more frequently in candidal (speckled) leukoplakia than in leukoplakia in generaland has been reported in as many as 50% of cases of candidal (speckled) leukoplakia in some series.Candida is known to cause epithelial proliferation, and this high number of cases of dysplasia may be exaggerated because of the induction of inflammatory or atypical (reactive) changes in the epithelium (ie, changes that do not constitute actual dysplasia). However, dysplastic and carcinomatous changes are more common in speckled leukoplakia than in homogeneous leukoplakia.