How are white sponge nevus, candidiasis or thrush differentiated from hairy leukoplakia?

Updated: Aug 05, 2019
  • Author: James E Cade, DDS; Chief Editor: Jeff Burgess, DDS, MSD  more...
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Answer

White sponge nevus, candidiasis, or thrush typically occurs as a flat lesion, removable by scraping, which reveals an erythematous base. However, hyperplastic candidiasis lesions are adherent and do not wipe off, making this disease especially difficult to distinguish from oral hairy leukoplakia (OHL). Resolution of the lesion with antifungal therapy suggests candidiasis over hairy leukoplakia. However, hairy leukoplakia lesions are commonly also infected with Candida, further confusing the clinical diagnosis. See the images below.

White sponge nevus. White sponge nevus.
Hyperplastic candidiasis. Hyperplastic candidiasis.

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