Leukoplakia vs Thrush

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

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