Thrush or leukoplakia/leukopenia


Dear Dr.

I have had a persistent white coating on my tongue for the past 4+ weeks. I've been positive 22 years, CD4 at 506, up from 19 two years ago (restarted meds), VL undetectable. I tried Periogard for 2 weeks and then 2 weeks of Diflucan. My doctor said on the phone that I might have hairy leukoplakia or leukopenia instead of thrush as it did not respond to treatment. I see her in two weeks.

My question is, what is the difference between thrush and hairy leukopenia and hairy leukoplakia and what are my treatment options? It doesn't hurt or bleed. By the way, I was really tired when all of this began. I'm on disablity and have been taking it very easy for the past few weeks especially since the beginning of this mess.

Thank you for your thoughts on this.


Thrush is a result of overgrowth of yeast in the mouth. It usually presents as while coat over mouth which can include the tongue, palate, cheeks, and/or back of throat. The key is that this can usually be scraped or brushed off. Hairy leukoplakia typically presents as a white brush-like border on the side of the tongue. Unlike thrush it can not be scraped off. Some people can have both at the same time.

Thrush is treated with one of several antifungal drugs. Hairy leukoplakia is associated with Epstein-Barr virus and sometimes responds to high doses of the antiviral drug acyclovir.

I suspect your doctor will be able to straighten this out for you.

Best, Eric