These lesions must be differentiated from the papillary-verrucous lesions, whose appearance is often white or white and red, is shown in this section and for which there is a different flowchart. If it has been established that the lesions are non-papillary-verrucous then the first question would be:
Clinical aspect of thrush.
The same patient after the removal of the white patches with gauze.
A plaque is flatter than a papillary-verrucous lesion ands
its surface presents a flat/irregular appearance
A) Single white spot or single white plaque :
A white macule is a flat lesion simply reflecting a change of the mucosal colour; it may be smooth or finely granular in texture
A white plaque is a thickened lesion (thickness ranging from 1 or few millimetres) with a slightly wavy surface, which is usually rough, at times crossed by lines. It can be a few millimetres or many centimetres wide, it varies.
B) Multiple white spots and multiple white plaques :
The white spots are similar to those described earlier on but spread over one area or several or the whole mucous membrane
The papules (1) are round white lesions, of
small diameter and quite numerous that tend to merge thus
creating multiform geometric patterns. Amongst which
white stripes (2) or the actual plaques (3) do stand out
C) White and red spots and plaques :
These are usually restricted to one area (e.g. the edge of the tongue, one of the buccal mucosa, the anterior floor of the mouth), and they are made of single white plaques, although often multiple, surrounded by red spots.
Another possible aspect is papules, plaques and white stripes associated to multiple red spots, spread over the
mucosa or just over the buccal mucosa symmetrically (see A and B). As it will be obvious from following the diagnostic
flowchart, this is the typical appearance of lichen.