Pathology · patient case question
A separate patient has reticular white striae bilaterally on the buccal mucosa. Biopsy shows Civatte bodies and a band-like lymphocytic infiltrate. What is the first-line treatment for the symptomatic form?
Patient case: White and Pigmented Oral Lesions
demo: 58-year-old male
chief: Routine examination; several mucosal findings noted.
history: Smokes one pack per day for 30 years. Occasional alcohol.
meds: None
findings: Finding 1: a small white plaque on the soft palate that does not wipe off. Finding 2: a white plaque on the lateral tongue border, 3 mm, non-wiping. Finding 3: a flat blue-grey macule in the buccal mucosa adjacent to a large amalgam restoration. Finding 4: irregular erythematous patches with white serpiginous borders on the dorsal tongue that shift location between visits. Finding 5: a bony hard midline swelling of the hard palate.
Show answer and explanation
Correct answer: C. Topical clobetasol propionate
- A. Nystatin treats candidiasis, which may be superimposed on steroid therapy but is not the primary disease.
- B. Acyclovir treats herpetic infection; lichen planus is a T-cell mediated autoimmune condition, a type IV hypersensitivity reaction.
- C. Correct. Civatte bodies (apoptotic basal keratinocytes) with a band-like T-lymphocyte infiltrate is lichen planus. High-potency topical corticosteroid — clobetasol — is first line for the erosive, symptomatic form.
- D. Excision is neither practical nor curative for a bilateral, chronic, immune-mediated mucosal disease.