Pathology · patient case question
A biopsy of an erosive white-striated buccal lesion shows Civatte bodies. What is the most appropriate treatment for the current findings?
Patient case: Two white lesions and a brown one
demo: Three patients seen in one session
chief: Assorted mucosal lesions identified during routine examination.
history: The first is a 24-year-old with a lifelong asymptomatic finding whose brother has the same appearance. The second is a 41-year-old with bilateral buccal findings. The third is a 52-year-old who has chewed betel nut for twenty years.
meds: None relevant.
findings: Patient one has a diffuse, thick, spongy, folded white lesion of the floor of the mouth and buccal mucosa that does not rub off. Patient two has a diffuse blue-grey filmy opacity of both buccal mucosae that fades when the cheek is stretched. Patient three has brownish-red clustered staining of the buccal mucosa near teeth 18 and 19 with a marbled pallor and reduced mouth opening.
Show answer and explanation
Correct answer: B. Topical clobetasol
- A. Acyclovir treats herpesvirus infection, which produces vesicles and ulcers without striae or Civatte bodies.
- B. Correct. Civatte bodies are apoptotic basal keratinocytes, the histological signature of lichen planus alongside a band-like lymphocytic infiltrate and basal cell degeneration. Symptomatic erosive disease is treated with a potent topical corticosteroid, and clobetasol propionate is the standard choice, with antifungal cover if candidiasis supervenes.
- C. Antibiotics have no role; lichen planus is immune-mediated, not bacterial.
- D. Clotrimazole treats candidiasis, which frequently overlies lichen planus but is not the primary disease being treated here.