Differential Diagnosis for Burning Mouth with White Plaques and Dark Pigmentation

• Single most likely diagnosis
  • Lichen planus: This condition is characterized by white, lacy patches and dark pigmentation, which matches the patient's symptoms. It can cause burning sensations in the mouth and is more common in older adults.
• Other Likely diagnoses
  • Leukoplakia: This condition presents with white plaques in the oral mucosa and can be associated with burning sensations. It's often related to chronic irritation and can be a precursor to oral cancer, but the presence of dark pigmentation is less typical.
  • Oral lichenoid lesions: These can appear similar to lichen planus and are also associated with a burning sensation. They can be caused by various factors, including hypersensitivity reactions.
  • Chronic cheek biting or other forms of oral habits: These can cause white plaques and dark pigmentation due to chronic irritation and may lead to burning sensations.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Oral cancer: Although less likely given the description, any oral lesion, especially those with a long duration, should prompt consideration of oral cancer. The presence of white plaques and dark pigmentation, along with burning sensations, necessitates ruling out malignancy.
  • Pemphigus vulgaris: This autoimmune disease can cause oral lesions and blisters, which might initially appear as white plaques. It's less common but critical to diagnose early due to its potential severity.
• Rare diagnoses
  • Oral melanoacanthoma: A rare, benign lesion that can present with dark pigmentation and sometimes a burning sensation, though it's less commonly associated with white plaques.
  • Dysplastic lesions: Though less common, any long-standing oral lesion should prompt consideration of dysplasia, especially if there are risk factors for oral cancer.