My daughter has a raspberry-like stain on the inside of her bottom lip from side to side. It looks like a minor abrasion. She also has some white stuff in the same area. I noticed today that her voice was changing in the manner towards a sore throat -- scratchy. A nurse said she hopes this isn't thrush. Are these the symptoms of thrush? If not, what is causing this?

M.

Thrush is an oral yeast infection. The offending organism is called Candida albicans. While the presentation may be subtle, the diagnosis is usually obvious. There are multiple small, white plaques on the mucosal surfaces of the lips or cheeks, beneath the tongue or on the back of the throat. The white plaques cannot be easily scraped aside. When the doctor does scrape one aside, the underlying mucosa may be very red and may bleed. When throat lesions are extensive, sore throat and hoarseness may be seen.

More subtle cases of thrush present with burning tongue, burning lips, sore throat and hoarseness in the absence of plaques. If there are no plaques, the diagnosis may be very tough to make. I will, at times, treat a patient for thrush if they have these symptoms yet have no other explanation for their problem.

What else might this be, if it is not thrush? One obvious possibility, especially considering your observation that it looks like an abrasion: She may have accidentally bitten her lower lip. The "raspberry-like stain" could represent submucosal hemorrhage, and the white patch would be a scab. Scabs in the oral cavity tend to be white or white-yellow, not brown as on skin. Any lip trauma (such as a burn from eating hot pizza) could produce this appearance.

I'm still pondering "raspberry-like." You might have just meant the color, or you might be referring to reddish or purplish bumps or dots. Oral herpes can have this appearance, but there's usually no exudate ("white stuff"). Hemangiomas, which are abnormal proliferations of small blood vessels, can also have this appearance. You probably would have noticed a hemangioma before this; however, if your daughter is less than one year old, she may have had a tiny hemangioma that has just now grown to an appreciable size. How would I explain the exudate? Perhaps she bit the hemangioma, but that would have been quite bloody -- impressively so.

I'm also pondering your comment that the nurse hopes it isn't thrush. Thrush is treatable. Why should she dread thrush? If she thinks it is thrush, why not treat it as such?

If your daughter's lip is still abnormal by the time you read this, I recommend that you take her to a pediatrician. If the pediatrician is stumped, take her to an oral surgeon or an ear, nose and throat doctor. The nurse is clearly uncertain as to the diagnosis, so it's up to you to pursue this until you have a real answer.