Oral Lichen Planus — ORE Part 1 MCQ

Instant feedback + full explanation. One question, done properly.

EasyOral MedicineOral Lichen PlanusORE Part 1

A 45-year-old woman presents with bilateral white lace-like striae on her buccal mucosae with erythematous areas. She reports a burning sensation when eating spicy food. What is the most likely diagnosis?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Oral lichen planus

The diagnosis is oral lichen planus (OLP), reticular form with erosive features. The key discriminatory findings are: (1) bilateral white lace-like striae (Wickham striae) on buccal mucosae—pathognomonic for reticular OLP and highly specific (90.9% specificity); (2) erythematous areas indicating erosive/atrophic component; (3) burning sensation triggered by spicy food, typical of erosive OLP. The patient's age (45 years) fits the peak incidence (46–60 years) and female predominance (2:1 ratio) of OLP. UK data show 95% of OLP presents bilaterally with the buccal mucosa as the most common site (89.2%). Lichenoid reaction lacks the pathognomonic bilateral reticular pattern and requires identifiable exogenous trigger. Leukoplakia does not produce characteristic lace-like striae. Oral candidiasis presents as pseudomembranous or erythematous patches without the striated morphology. Lupus erythematosus causes erythematous plaques with surface ulceration, not lace-like white striae. Diagnosis should be confirmed histologically; the clinical presentation is highly specific.

Reference: Oral lichen planus: a retrospective study of 690 British patients. PubMed. https://pubmed.ncbi.nlm.nih.gov/16910916/; Mucoscopic Features of Oral Lichen Planus: A Retrospective Comparative Study with Inflammatory Mimickers. PMC. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12071921/; Oral Lichen Planus: An Updated Review of Etiopathogenesis, Clinical Presentation, and Management. PubMed. https://pubmed.ncbi.nlm.nih.gov/38283029/