Leukoplakia vs. Oral Candidiasis

Oral Leukoplakia

• Flat, white lesions that cannot be brushed from the oral mucosa

• Typically painless

• Associated with tobacco and alcohol use

• Associated with squamous cell carcinoma

• Erythroplakia: similar lesions, but with a red appearance

  • Carry a higher risk of dysplasia or carcinoma

• Malignant potential warrants biopsy

• Management: alcohol and smoking cessation, consider surgical removal

Oral Candidiasis (Thrush)

• Caused by Candida albicans

• White, creamy plaque that easily brushes off, with underlying erythema

• Typically associated with throat or mouth pain

• Risk factors for infection

  • Immunocompromised states

  • HIV

  • Radiation or chemotherapy

  • Diabetes

  • Systemic or inhaled corticosteroid use

  • Broad-spectrum antibiotics

  • Dentures

• Typically associated with throat or mouth pain

• KOH preparation demonstrates budding yeasts, hyphae, or pseudohyphae

• Treatment is with antifungals

  • Nystatin liquid

  • Oral fluconazole

  • Clotrimazole troches

Oral Hairy Leukoplakia

• Caused by Epstein-Barr virus (human herpesvirus 4)

• Most commonly affects immunocompromised patients (e.g. HIV)

• White, hyperkeratotic plaque that cannot be brushed off

• Usually distributed along the lateral border of the tongue

• Vertical white striations may appear “hairy”

• Lesions are typically painless and benign

• Treatment for lesions not usually required; antivirals may be considered