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Lichen Planus — SCE Dermatology MCQ

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EasyInflammatory DermatosesLichen PlanusSCE Dermatology

A 48-year-old woman presents with violaceous, polygonal, flat-topped papules on her wrists and ankles with fine white lines (Wickham striae) visible on the surface. She also has lacy white reticulate patches on her buccal mucosa. Biopsy shows a band-like lymphocytic infiltrate at the dermoepidermal junction with civatte bodies. What is the most likely diagnosis?

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Correct answer: E — Lichen planus

This is a classic presentation of lichen planus: the 6 Ps (purple/violaceous, polygonal, planar/flat-topped, pruritic papules with Wickham striae). Oral involvement with reticulate white patches (Wickham striae pattern on buccal mucosa) is common. Histologically, the band-like (lichenoid) lymphocytic infiltrate at the DEJ with civatte bodies (apoptotic keratinocytes) and saw-tooth acanthosis is characteristic. Secondary syphilis can mimic LP but lacks Wickham striae and has different histology.

Reference: BAD 2019 Guidelines for management of lichen planus