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Quiz
Mixed diagnoses – 10 cases (9 of 11)

For each of the ten cases, study the image(s) and then answer the questions. You can click on the image to view a larger version if required.

Each case should take approximately five minutes to complete. There is a list of suggested further reading material at the end of the quiz.

When you finish the quiz, you can download a certificate.

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.

This is oral lichen planus. Note a reticulate pattern of white lines on the buccal mucosa and the lateral side of the tongue.

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.

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.

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.

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