Pathology · single question
A patient presents with white plaques on the soft palate that wipe off easily. They use an albuterol inhaler regularly. The MOST likely diagnosis is:
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Correct answer: D. Oral candidiasis (pseudomembranous)
Pseudomembranous candidiasis (thrush) presents as white wipeable plaques that reveal an erythematous base when removed. In asthmatic patients using inhaled corticosteroids (like albuterol/fluticasone), the immunosuppressive effect of steroids deposited in the oropharynx promotes Candida overgrowth. Management: antifungal (nystatin or fluconazole) and advise rinsing mouth after inhaler use.
- A. ❌ Nicotinic stomatitis affects the hard palate of heavy smokers with white papular changes and red dots — not wipeable plaques from inhaler use.
- B. ❌ Leukoplakia does not wipe off — it is a precancerous white patch adherent to mucosa.
- C. ❌ Lichen planus presents as non-wipeable white lace-like (reticular) or erosive lesions — not easily wiped off.
- D. ✅ CORRECT – Pseudomembranous candidiasis presents as white wipeable plaques. Inhaler use (especially inhaled corticosteroids) is a classic risk factor.