Combined Laser And Photodynamic Therapy For Chronic Hyperplastic Candidiasis

Chronic hyperplastic candidiasis (CHC) often resists conventional antifungal therapy and may progress to epithelial dysplasia or malignant transformation, potentially requiring surgical intervention. This case demonstrates the efficacy of combined laser and photodynamic therapy (PDT) for CHC, offering a minimal invasive alternative. A 45-year-old female presented with a one-month history of a proliferative lesion on the right buccal mucosa. Physical examination revealed a 30×20mm papillary hyperplasia lesion on the right buccal mucosa, with an erosive area in the anterosuperior region. Histopathological examination confirmed the diagnosis of CHC with mild epithelial dysplasia. Initial treatment with fluconazole and nystatin for three weeks reduced erosion but left residual hyperplasia. Semiconductor laser ablation was performed to remove the lesion, followed by topical 5-aminolevulinic acid photodynamic therapy (ALA-PDT). At one-month follow-up, complete healing was observed without recurrence. The treatment of CHC poses challenges of persistent Candida infection and epithelial dysplasia with malignant potential. Conventional antifungal therapy often fails to penetrate hyperkeratotic lesions, while surgical excision risks functional impairment, particularly in extensive lesions. ALA-PDT exerts dual therapeutic effects: reactive oxygen species eliminate Candida biofilms and selectively trigger apoptosis in dysplastic cells to prevent precancerous progression. Laser ablation reduced hyperkeratotic tissue thickness, facilitating deeper ALA diffusion to eliminate subepithelial fungal infiltrates, and overcame limited penetration depth of PDT. This combined approach achieved complete lesion resolution without functional impairment, offering a minimal invasive alternative. The combination of laser and PDT provides a novel, safe and effective alternative for CHC.