Differential Diagnosis for White Tongue Plaque in a 26-year-old Healthy Male
- Single most likely diagnosis
- Oral thrush (candidiasis): This is the most common cause of white tongue plaque, especially in young, healthy individuals. It is often associated with poor oral hygiene, antibiotic use, or immunosuppression, but can occur in anyone.
- Other Likely diagnoses
- Leukoplakia: A condition characterized by a white patch or plaque on the tongue or mucous membranes that cannot be rubbed off. It is often associated with chronic irritation, such as from tobacco use or habitual cheek biting.
- Lichen planus: An autoimmune condition that can cause white, lacy patches on the tongue and mucous membranes.
- Geographic tongue: A benign condition characterized by patches on the tongue that give it a "geographic" appearance, sometimes with white borders.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Oral cancer: Although rare in young, healthy individuals, oral cancer can present as a white patch or plaque on the tongue. It is crucial to rule out this diagnosis, especially if there are risk factors such as tobacco or alcohol use.
- Syphilis (secondary): This sexually transmitted infection can cause a variety of oral lesions, including white patches or plaques on the tongue.
- HIV-related oral lesions: Certain oral conditions, such as oral hairy leukoplakia, can be associated with HIV infection.
- Rare diagnoses
- Pemphigus: A group of autoimmune diseases that can cause blistering of the skin and mucous membranes, including the tongue.
- White sponge nevus: A rare, benign condition that causes white, spongy lesions on the tongue and mucous membranes.
- Darier's disease: A rare genetic disorder that can cause white, crusted lesions on the tongue and mucous membranes.