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Pharmacology · patient case question

Which is the appropriate first-line treatment for the symptomatic form?

Patient case: 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.

  1. A systemic antiviral such as aciclovir
  2. A topical corticosteroid such as clobetasol
  3. Surgical excision of the affected mucosa
  4. A topical antifungal such as nystatin
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.

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