Differentials
Chemical burns
SIGNS / SYMPTOMS
May be asymptomatic.
May be a history of contact with chemical agent, most commonly from topical use of aspirin for toothache.
White plaques cannot be scraped off.
After elimination of the etiologic factor, lesions will resolve in 7-14 days.
INVESTIGATIONS
Smear exam and periodic acid-Schiff staining will be negative for yeast forms or hyphae.
Reactive keratosis
SIGNS / SYMPTOMS
Lesions are usually asymptomatic.
May be able to identify a source of chronic irritation (e.g., a faulty dental restoration, an ill-fitting denture, or parafunctional habits such as bruxism or chronic cheek biting).
INVESTIGATIONS
Definitive diagnosis is always through biopsy and histologic evaluation of the lesion.
Hairy leukoplakia
SIGNS / SYMPTOMS
Lesions are asymptomatic.
INVESTIGATIONS
Definitive diagnosis is through biopsy and histologic evaluation of the lesion.
In situ hybridization technique demonstrates the presence of EBV in the tissue.
Plaque-type lichen planus
SIGNS / SYMPTOMS
Lesions are usually asymptomatic.
There may be other lichenoid lesions in other areas of the skin.
INVESTIGATIONS
Definitive diagnosis is through biopsy and histologic evaluation of the lesion.
Immunofluorescence staining of the tissue sample may provide additional evidence for the diagnosis, although it is infrequently performed.
Erosive lichen planus
SIGNS / SYMPTOMS
Lesions are painful, but mostly when eating, whereas erythematous candidiasis may be associated with constant burning pain.
Mucosal erosions and lichenoid lesions elsewhere on the skin may be present.
INVESTIGATIONS
Definitive diagnosis is through biopsy and histologic evaluation of the lesion and immunofluorescence staining of the tissue sample if additional diagnostic information is necessary.
Premalignant leukoplakia and carcinoma
SIGNS / SYMPTOMS
Lesions are usually asymptomatic unless the expansion of malignancy encroaches on anatomic relationship between tissues.
Regional lymph nodes may be enlarged.
INVESTIGATIONS
Definitive diagnosis is through biopsy and histologic evaluation of the lesion.
Imaging techniques such as x-ray or CT are useful to determine local invasion of carcinoma.
Thermal burns
SIGNS / SYMPTOMS
Lesions are usually painful but difficult to distinguish from erythematous candidiasis based on symptoms.
Lesions are often local, and adequate history may indicate an incidence of burn with food.
Lesions resolve in 7-14 days with no intervention.
INVESTIGATIONS
No differentiating tests required.
Migratory glossitis
SIGNS / SYMPTOMS
Lesions are usually asymptomatic.
In patients who do complain of discomfort, burning is associated with eating spicy or sour food or alcohol-containing liquids, whereas symptomatic erythematous candidiasis is associated with constant burning.
Atrophic zones of migratory glossitis are commonly patchy and are usually surrounded by elevated hyperkeratotic margins.
INVESTIGATIONS
In the absence of clinically distinguishable features, histologic exam of the tissue may be necessary.
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