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Triggers of elevated ceramide levels comprise hyperosmotic shock [122], secreted sphingomyelinases (SMases) during inflammation [125], sepsis [126] or severe coronavirus disease 2019 (COVID-19) [127], Clostridium perfringens epsilon toxin [128], and platelet-activating factor [129]

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Exogenous oestrogen in combined oral contraceptive pills and hormone replacement therapy directly enhances Candida adherence to mucosal surfaces via oestrogen receptor-mediated upregulation of Candida adhesins

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That creates the conditions tissue needs to actually heal [1]

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