Differential Diagnosis for White Spots on Buccal Mucosa with Canker Sore and Possible Cold Sore

• Single Most Likely Diagnosis
  • Oral candidiasis (thrush) with concurrent canker sore (aphthous ulcer) and possible cold sore (herpes simplex virus): This combination is common due to the immunocompromised state that can occur with oral candidiasis, making the patient more susceptible to other infections like herpes simplex virus and aphthous ulcers.
• Other Likely Diagnoses
  • Leukoplakia: A condition where thick, white patches or lesions appear on the tongue, the bottom of the mouth, or on the mucous membranes lining the inside of the mouth. It could be related to chronic irritation from canker sores or cold sores.
  • Lichen planus: An inflammatory condition that affects mucous membranes inside the mouth, characterized by white, lacy patches; red, inflamed tissues; or open sores. It can coexist with other oral conditions.
  • Oral hairy leukoplakia: Typically seen in immunocompromised patients, especially those with HIV/AIDS, presenting as white patches on the lateral surface of the tongue that cannot be wiped away.
• Do Not Miss Diagnoses
  • Squamous cell carcinoma: Although less likely, any persistent white patch or lesion in the mouth could be a sign of oral cancer, especially in patients with risk factors like smoking or chewing tobacco.
  • Secondary syphilis: Can manifest with mucous patches in the mouth, which are painless, white, and can resemble other conditions like thrush.
• Rare Diagnoses
  • Pemphigus vulgaris: A rare autoimmune disorder that can cause blistering of the skin and mucous membranes, including the mouth, though it typically presents with painful blisters rather than white spots.
  • White sponge nevus: A rare, benign condition that affects the mucous membranes, causing them to thicken and become white. It is usually present from birth or appears during childhood.