White plaques that wipe off in an inhaler user
66-year-old female
§Chief complaint
White coating in the mouth and altered taste for 3 weeks
§Medical & dental history
- 01Asthma on a high-dose inhaled corticosteroid, does not rinse after use
- 02Type 2 diabetes, HbA1c 8.9 percent
- 03Wears an upper acrylic partial denture day and night
§Clinical examination
- 01Creamy white plaques on the palate and buccal mucosa that wipe off leaving an erythematous base
- 02Angular cheilitis bilaterally
- 03Denture-bearing palatal mucosa erythematous and well demarcated
- 04No induration or ulceration
§ figuresFigures (2)
Fig. 1Thrush in a child who had taken antibiotics.
“Human tongue infected with oral candidiasis” · James Heilman, MD · CC BY-SA 3.0 · Wikimedia Commons
Fig. 2Oral thrush. Aphthae. Candida albicans.
“Oral thrush Aphthae Candida albicans. PHIL 1217 lores” · Photo Credit: Content Providers(s): CDC · Public domain · Wikimedia Commons
Verified open-access images only, reproduced for education under their stated licences · no AI-generated or illustrative artwork · Oral Candidiasis figures pending faculty review.
§Differential diagnosis
§Final diagnosis
Pseudomembranous and denture-associated erythematous candidiasis with angular cheilitis
The single most useful bedside test is wiping the plaque: removal leaving raw erythema separates candidiasis from every keratotic white lesion. Uncontrolled diabetes, steroid inhaler use and continuous denture wear are the three local and systemic predisposing factors here.
§Investigations
- 01Oral rinse or swab for Candida culture and speciation
- 02Smear with PAS stain — pseudohyphae
- 03HbA1c and random blood glucose
- 04Haematinics if recurrent
§Treatment plan
- 01Topical nystatin or miconazole gel for 14 days (avoid miconazole with warfarin)
- 02Fluconazole 50 mg daily for 7-14 days if extensive
- 03Denture hygiene: remove at night, soak in chlorhexidine or hypochlorite for acrylic
- 04Rinse mouth after inhaler use, use a spacer, optimise glycaemic control
§Follow-up & outcome
- 01Complete resolution at 3 weeks
- 02No recurrence once diabetes control and denture hygiene improved
§Clinical pearls / learning points
- 01Candidiasis is a disease of the host, not the fungus — always look for why.
- 02Miconazole potentiates warfarin dangerously; check the drug chart before prescribing.
- 03Unexplained oral candidiasis in a young adult warrants HIV testing.
§ evidenceReferences & Evidence
Current Classification
WHO Classification of Tumours Online — Head and Neck
IARC / WHO · 2022
Continuously updated online edition of the WHO head and neck tumour classification.
Evidence summary
Highest level of evidence linked to this page: WHO / Official Classification.
- L1 · Classification — 1
- L2 · Guideline — 1
- L6 · Textbook — 3
1 linked source was published from 2024 onwards. Where guidance is limited or contested, rely on the higher-level sources above rather than this summary. Educational use only — not a substitute for clinical judgement.
Content last reviewed
September 2026
Evidence last reviewed
September 2026
Next scheduled review
September 2027
Review status
EVIDENCE REVIEWED
Search latest PubMed evidence
Last literature search: 7 September 2026
Current Classification
IARC / WHO. IARC · 2022
Continuously updated online edition of the WHO head and neck tumour classification.
Clinical Guidelines
Pappas PG, Kauffman CA, Andes DR et al.. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2016 · 62(4):e1-50
IDSA clinical practice guideline covering oropharyngeal, oesophageal and invasive candidiasis management.
Histopathology References
Barnes L. CRC Press · 2008
Detailed histopathological reference for head and neck diagnostic criteria.
Textbook References
Neville BW, Damm DD, Allen CM et al.. Elsevier · 2024
Standard reference textbook of oral and maxillofacial pathology used throughout this atlas.
Rajendran R, Sivapathasundharam B. Elsevier · 2020
Undergraduate and postgraduate oral pathology textbook widely used in BDS and FCPS curricula.
Additional sources cited on this page
- Neville BW et al. Oral and Maxillofacial Pathology, 5th ed.
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