GP Quiz 6 - Case 3.
A middle-aged lady presents with a sore mouth. Examination showed a reticulate white pattern on the buccal mucosa and the sides of her tongue.
What is this condition?
This is oral lichen planus. Note a reticulate pattern of white lines on the buccal mucosa and the lateral side of the tongue.
What other areas should be examined?
The entire skin should be examined, but particularly the wrists, lower back and ankles. Look for firm flat-topped violaceous plaques with slight white scaling or lines (Wickham's striae). They may be itchy.
How can you confirm the diagnosis?
The diagnosis can be confirmed by biopsy of the affected mucosa or other affected areas of skin. If the clinical presentation is typical, biopsy is not usually necessary.
How can it be treated?
Asymptomatic cases do not require treatment as the condition remits spontaneously. Symptomatic lichen planus responds to corticosteroids. Mild cases should be treated with topical steroid e.g. Kenalog in Orabase. Painful ulceration may require oral steroid therapy. When control proves difficult, or the presentation is atypical, referral to an oral surgeon or dermatologist is indicated.
This quiz was originally published by ADIS International in May 1998