A patient presents with white non-wipeable bilateral striations on the hard palate and bilateral buccal mucosa. No skin involvement. Which disease is MOST likely?

Correct answer: D. Systemic lupus erythematosus (SLE) — oral manifestations include white striations resembling lichen planus

• A. Lichen planus also causes bilateral white striations (Wickham striae) — the distinction in this question rests on the SLE medical history provided in the patient box.
• B. MMP causes subepithelial blistering with desquamative gingivitis — not bilateral striated white lesions.
• C. EM causes acute targetoid lesions — not bilateral white striations.
• D. Correct. White non-wipeable bilateral striations on both hard palate and buccal mucosa — while this RESEMBLES lichen planus — when combined with the medical history of SLE (autoimmune), this presentation is most consistent with SLE oral manifestations. SLE can cause oral lesions with Wickham striae-like white striations. The bilateral palate + buccal involvement with SLE history points to SLE.