Review Question - QID 109290

This patient is presenting with easily dislodged white plaques on her oral mucosa and a history of inhaled corticosteroids that is suspicious for the diagnosis of oral candidiasis, which can be treated with nystatin.

Oral thrush is caused by an infection from Candida yeast. It appears as soft white or yellow “curd-like” plaques on the tongue or oral mucosa (Figure A), which can easily be scraped off. A common risk factor for oral thrush is inhaled corticosteroids. Nystatin “swish and swallow” suspension can be used for treatment.

Figure A shows a photograph of soft, white plaques on the patient’s oral mucosa.

Incorrect Answers:
Answer 1: Acyclovir can be used to treat symptomatic oral hairy leukoplakia, which is associated with HIV and EBV infections. Oral hairy leukoplakia can appear as irregular, non-painful patches on the side of the tongue that have folds and protrusions, which appear hair-like. Unlike oral thrush, these lesions cannot be dislodged.

Answer 3: Smoking cessation is the only treatment for nicotine stomatitis. Nicotine stomatitis is clinically diagnosed based on the patient’s history and the appearance of a hard palate with characteristic white “cracks” (likened to “dried mud”) and numerous scattered red papules.

Answer 4: Surgical removal would be indicated for oral squamous cell carcinoma or even its precursor, oral leukoplakia, if there is evidence of moderate or severe epithelial dysplasia. Oral leukoplakia can appear as a white patch that is either flat or nodular. The lesion would not scrape away easily.

Answer 5: Topical betamethasone is first-line treatment for oral lichen planus. Lichen planus can be associated with hepatitis C. The oral lesions of lichen planus can appear as painless white streaks on the inside of the cheeks and sides of the tongue that are not easily scraped away.

Bullet Summary:
Inhaled corticosteroids can predispose a patient to oral thrush, which can be treated with a nystatin suspension.