I, unfortunatly, have no real clue what I am looking at... but when i look at the pictures of oral hary leucoplacia, thrush, and coated toung... i see almost the same thing. Is the Candidiasis supposed to be that stuff in the middle of the toung where no white stuff grows... and as far as hary leucoplacia... that looks like coated tongue on the side of the tongue... ah im so confused. Basicly, my question is how do you tell the diffrence? Is hary leucoplacia smell or hurt, is Candidiasis a clear patch in the middle or white on the outsides... and what distinguishes them from coated tongue?

I think the best way to answer this question would be to give a brief description of all of the oral manifestations you mention.

Candidiasis:

There are three main types of candidiasis which present in and around the oral cavity: angular cheilitis, erythematous candidiasis, and pseudomembranous candidiasis.

Angular cheilitis presents as a cracking or fissuring at the corners of the mouth. You do not have to be HIV+ or immunocompromised to present with this condition, as it is common in the general population. Angular cheilitis does tend to occur more frequently in patients which are immunocompromised, but in no way is this indicative of HIV infection. Treatment of this manifestation involves the use of topical antifungal creams or ointments such as Nizoral cream directly applied to the affected areas 4 times a day for a period of two weeks.

Erythematous candidiasis presents as a red, flat, subtle lesion, normally on the dorsal (top) surface of the tongue and/or the hard and soft palates. People who present with erythematous candidiasis commonly have symptoms of burning or oral discomfort, especially when eating salty or spicy foods or drinking acidic beverages such as orange or grapefruit juices. Treatment involves the use of topical antifungal agents such as Mycelex troches, 5 times a day again for a two week period of time. It is very important when treating any form of candidiasis to treat for the entire two week period of time as this will help prevent recurrence.

Pseudomembranous candidiasis (thrush) presents as white or creamy plaques that can appear anywhere within the oral cavity that will *wipe away* sometimes leaving a red or a bleeding surface. Treatment depends on the extent of disease. For mild to moderate presentations, treatment should involve the use of topical antifungal agents such as Mycelex troches. For more extensive presentations a systemic agent such as fluconazole should be used.

Oral Hairy Leukoplakia (OHL):

OHL presents as a white, corrugated (rough) lesion that normally appears on the lateral borders of the tongue. OHL is related to the Epstein-Barr virus. The key to differentiating between pseudomembranous candidiasis (thrush) and oral hairy leukoplakia is that OHL will *not wipe away* and is usually limited to the sides of the tongue. OHL is not painful, nor does it bleed. Treatment is not usually necessary as we have seen a reduction in the occurrence of this lesion since the advent of HAART.

Coated tongue is an overgrowth of bacteria and/or an elongation of the normal papillae of the tongue which only appears on the dorsal surface (top) of the tongue. This manifestation, which is NOT related to HIV infection, is white or creamy in appearance and is associated with dry mouth, smoking, drinking and drug use. The keys in identifying this manifestation is that it only appears on the top of the tongue and that you cannot completely wipe it away as you can with thrush.

I hope this answers your question.

DR