Pathology · patient case with 2 questions
Woman with white striae on the buccal mucosa
Patient: Female, 50 years old
Chief complaint: Rough, occasionally sore areas inside the cheeks.
Background: No relevant medical history reported.
Current findings: Bilateral white striae on the buccal mucosa that cannot be wiped away.
Question 1
What is the diagnosis?
Show answer and explanation
Correct answer: C. Oral lichen planus
- A. Leukoplakia is usually a solitary homogeneous patch, not bilateral symmetrical striae.
- B. Candidal plaques WIPE OFF, and are typically not symmetrical striae.
- C. CORRECT. Bilateral, symmetrical white striae on the buccal mucosa that do not rub off are WICKHAM STRIAE, the hallmark of reticular ORAL LICHEN PLANUS. It is a T-cell mediated condition targeting the basal keratinocytes, and histology shows a band-like lymphocytic infiltrate at the interface with basal cell degeneration.
- D. Lupus lesions can resemble lichen planus but are typically asymmetrical, with radiating striae around a central erythematous zone.
Question 2
Which is the appropriate first-line treatment for the symptomatic form?
Show answer and explanation
Correct answer: B. A topical corticosteroid such as clobetasol
- A. This is not a viral condition.
- B. CORRECT. Symptomatic lichen planus responds to TOPICAL CORTICOSTEROIDS, which suppress the T-cell mediated attack on the basal layer. Clobetasol is a high-potency choice for resistant erosive disease. Asymptomatic reticular lesions need no treatment, only periodic review.
- C. Excision is neither practical for widespread bilateral disease nor curative, since the condition is immunologically driven.
- D. Antifungals are relevant only for superimposed candidiasis, which is a common secondary complication of prolonged topical steroid use.
Note: Erosive lichen planus carries a small but genuine risk of malignant transformation, generally cited at under 1%. Long-term review is warranted.