Phenotypic Species Identification and Antifungal Susceptibility of Oral Candida albicans in Patients with Oral Lichen Planus: A Case Control Pilot Study

Introduction: Oral lichen planus (OLP) is an immune-mediated chronic inflammatory disease of the oral cavity. Candida superinfection requires special management due to its ability to increase disease severity and the risk of malignant transformation. This pilot study aimed to determine different phenotypes of Candida and the susceptibility of Candida albicans to commonly used antifungals in patients with OLP compared to disease-free controls. This was a case-control study. Materials and Methods: Following ethical clearance and informed consent, OLP patients ( n  = 25) and disease-free controls ( n  = 23) were enrolled. Swab samples were collected from the buccal mucosa and tongue. Species-level identification of Candida was conducted using culture methods, and an antifungal susceptibility test was performed for isolated C. albicans using the disk diffusion method for fluconazole and amphotericin B. Data analysis was performed using the IBM SPSS software. Results: From the OLP group, 11 (44%) tested positive for Candida , while in the control group, only 30.4% were positive, with no statistically significant difference (chi-square test, P =  0.332). All positive samples demonstrated pure C. albicans growth except one, which showed mixed growth. In the antifungal susceptibility testing, 18.2% of the OLP group and 14.3% of the control group were resistant to fluconazole. Both groups displayed complete resistance (100%) to amphotericin B. Conclusion: This pilot study reveals an increase in the presence of Candida in OLP patients compared to disease-free controls. In both groups, the most prevalent species was C. albicans . Most of the C. albicans strains appeared sensitive to fluconazole, but resistant to amphotericin B.