Differential Diagnosis for White Patches on Tongue that Bleed when Scraped

• Single Most Likely Diagnosis
  • Oral thrush (candidiasis): This is the most likely diagnosis due to the presence of white patches on the tongue that can bleed when scraped. Oral thrush is a common fungal infection that can cause these symptoms, especially in immunocompromised individuals or those with poor oral hygiene.
• Other Likely Diagnoses
  • Leukoplakia: This condition is characterized by white patches on the mucous membranes, including the tongue, which can sometimes bleed when scraped. Leukoplakia can be associated with chronic irritation or tobacco use and has a potential for malignant transformation.
  • Lichen planus: Although less common, oral lichen planus can present with white, lacy patches on the tongue and other mucous membranes. These lesions can be sensitive and may bleed when scraped.
  • Traumatic keratosis: This condition results from chronic irritation or trauma to the tongue, leading to the formation of white patches that can bleed when scraped.
• Do Not Miss Diagnoses
  • Oral cancer: Although less likely, it is crucial not to miss oral cancer, as it can present with white patches (leukoplakia) that bleed upon scraping. Early detection is key to effective treatment.
  • Histoplasmosis: In immunocompromised patients, histoplasmosis can cause oral lesions, including white patches on the tongue that may bleed. Given its potential severity, it should not be overlooked.
• Rare Diagnoses
  • Pemphigus vulgaris: This is a rare autoimmune disease that can cause blistering of the skin and mucous membranes, including the tongue. The blisters can rupture, leaving behind erosions that may appear as white patches and bleed when scraped.
  • Secondary syphilis: In its secondary stage, syphilis can cause a variety of oral manifestations, including white patches on the tongue. Although rare, syphilis is a significant diagnosis that should be considered, especially in patients with risk factors.