Can prednisone (corticosteroid) cause a throat rash if I eat yogurt, and is it bacterial or fungal in nature?

Prednisone and Throat Rash After Yogurt Consumption

Prednisone can increase the risk of oral candidiasis (fungal infection) in the throat, which may appear as a rash or white patches after yogurt consumption due to immunosuppression. 1

Mechanism and Risk Factors

Corticosteroids like prednisone compromise the immune response and increase susceptibility to opportunistic infections 1. Specifically:

• Corticosteroid use is more commonly associated with fungal infections, particularly Candida species 1
• Doses equivalent to ≥20 mg of prednisolone for ≥2 weeks significantly increase infection risk 1
• The immunosuppressive effect allows opportunistic organisms to proliferate in the oral cavity and throat

Diagnosis

The throat rash after yogurt consumption while on prednisone is most likely fungal in nature (candidiasis) rather than bacterial:

1. Visual appearance:

   • Fungal: White or cream-colored patches that can be scraped off, leaving red or bleeding areas underneath
   • May appear as redness or irritation in the throat

2. Timing and association:

   • Symptoms appearing after yogurt consumption suggest the yogurt may be serving as a growth medium for fungal organisms already present due to immunosuppression
   • Yogurt itself is not typically a cause of throat rash in non-immunocompromised individuals 2, 3

Management

1. Antifungal treatment:

   • For oral/throat candidiasis, topical antifungal medications like nystatin oral suspension or clotrimazole troches
   • For more severe cases, systemic antifungals like fluconazole may be needed

2. Prednisone management:

   • Continue prednisone as prescribed for the underlying condition
   • Consider tapering to the lowest effective dose if medically appropriate 4
   • Do not abruptly discontinue prednisone

3. Dietary modifications:

   • Temporarily avoid yogurt and other dairy products until the infection resolves
   • Consider probiotic supplements that don't contain dairy if beneficial for underlying condition

Prevention

1. Oral hygiene:

   • Maintain excellent oral hygiene while on prednisone
   • Rinse mouth with water after using inhaled corticosteroids (if applicable)
   • Consider prophylactic antifungal rinses for long-term high-dose prednisone therapy

2. Dietary considerations:

   • Limit consumption of sugary foods that can promote fungal growth
   • If yogurt is beneficial for your condition, consider resuming after the infection clears

When to Seek Further Medical Attention

Consult your healthcare provider if:

• Symptoms persist despite treatment
• You develop difficulty swallowing or breathing
• The rash spreads or worsens
• You develop fever or other systemic symptoms

Special Considerations

While some studies suggest yogurt may have immunostimulatory effects 5, 6, these benefits are outweighed by the risk of exacerbating fungal infections in immunocompromised patients on prednisone. The combination of immunosuppression from prednisone and the potential for yogurt to serve as a growth medium for Candida creates conditions favorable for throat candidiasis.