Chronic Mucocutaneous Candidiasis Immunology and Therapies

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This online-only bonus feature is an ongoing review of past peer review journal articles with significant impact on dermatology.

Chronic Mucocutaneous Candidiasis: Immunologic Studies of 3 Generations of a Single Family

A case series published by Jorizzo, et al studied 8 members in 3 generations along with 3 unaffected relatives to help further elucidate the underlying mechanism of chronic mucocutaneous candidiasis. The authors performed a battery of tests including the following: fungal cultures through skin scrapings, autoantibody studies, humoral immune studies, examining HLA haplotypes, performing skin tests and Dinitrochlorobenzene sensitization tests, measuring T and B cell counts, examining cell preparation for chemotaxis, studying lymphocyte transformation, and measuring candida antigen and antibody levels. While many of the aforementioned studies were normal compared to the control populations, there were some interesting findings. The fungal cultures revealed that all family members (except for 1) had either clinical and/or mycologic disease. The authors noted that lymphocyte transformation was impaired in patients with clinical disease (except for 1). In several of the patients, leukocyte inhibitory factor to candida was not produced in several of the patients, and only 2 of the patients could produce high levels of this, however even if produced, it was ineffective. Most patients had decreased leukocyte transformation to Candida antigen and all but one patient had a negative intradermal sensitization test to Candida. This study suggests that there is an autosomal dominant inheritance of this disease and that the etiology of chronic mucocutaneous candidiasis is complex and multifactorial.

Reference

Sams WM, Jorizzo JL, Snyderman R, et al. Chronic mucocutaneous candidiasis. Immunologic studies of three generations of a single family. Am J Med. 1979;67(6):948-59.

Evaluation of Immune-Enhancing Effects of Ibuprofen in an Immunodeficiency Model

A separate case study by Jorizzo et al. (Jorizzo, 1985) sought out to investigate the efficacy of ibuprofen therapy in patients with chronic mucocutaneous candidiasis. The proposed mechanism is through the inhibition of prostaglandin formation – which prevents the latter molecules from down regulating the cell-mediated immune system. A total of 4 patients with recalcitrant, chronic mucocutaneous candidiasis underwent treatment with ibuprofen. Augmentation of the cell mediated immune system was assessed through delayed hypersensitivity tests which were performed both prior and during oral ibuprofen therapy. While ibuprofen may have some theoretic efficacy in the treatment of chronic mucocutaneous candidiasis, the findings of this case study did not support its use.

Reference

Jorizzo JL, Goldblum RM, Daniels JC, Ichikawa Y, Langford MP, Fagan KM. Evaluation of immune-enhancing effects of ibuprofen in an immunodeficiency model. Int J Dermatol. 1985;24(3):183-7.

Cimetidine as an Immunomodulator: Chronic Mucocutaneous Candidiasis as a Model

Although ibuprofen did not demonstrate compelling efficacy in enhancing cell mediated immunity in patients with chronic mucocutaneous candidiasis, a third case study by Jorizzo and colleagues (Jorizzo, 1980) investigated whether cimetidine would be effective. Just as prostaglandins inhibit cell mediated immunity, there is also evidence that histamine plays a very similar role, which cimetidine would block. Four chronic mucocutaneous candidiasis patients who all had negative candida skin tests were treated with cimetidine.  During therapy, all 4 patients had their candida skin tests become positive, however this was not sustained with cessation of treatment. Given these findings, adjuvant treatment with cimetidine may provide a benefit in a subset of patients with chronic mucocutaneous candidiasis.

Reference

Jorizzo JL, Sams WM Jr, Jegasothy BV, Olansky AJ. Cimetidine as an immunomodulator: chronic mucocutaneous candidiasis as a model. Ann Intern Med. 1980;92(2 Pt 1):192-5.