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Lichenoid Reaction Hydroxychloroquine — ORE Part 1 MCQ

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ModerateOral MedicineLichenoid Reaction HydroxychloroquineORE Part 1

A 52-year-old woman attends with an asymptomatic white reticular patch on the left buccal mucosa. It appeared 6 weeks after hydroxychloroquine was started for systemic lupus erythematosus. The lesion is non-ulcerated, there is no induration or cervical lymphadenopathy, and there are no red areas. What is the most appropriate initial management?

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Correct answer: D — Record a probable lichenoid drug reaction and liaise with the prescriber about medication review

The temporal association with starting hydroxychloroquine and the reticular buccal lesion make an oral lichenoid drug reaction the most likely working diagnosis. The appropriate first step is to document the suspected adverse drug reaction and liaise with the prescribing clinician about whether the medicine can be reviewed or substituted; the dentist should not stop treatment independently. Immediate biopsy is not the best initial action in this clinically low-risk presentation, although referral or biopsy is appropriate if the lesion persists after drug review, becomes atypical, or develops suspicious features. Topical corticosteroids may be used for symptomatic lichenoid disease, but this lesion is asymptomatic and treatment would not address a possible drug trigger. Reassurance alone and extraction of an adjacent tooth are inappropriate.

Reference: McCartan BE, Lamey PJ. Oral lichenoid drug eruptions: their recognition and management. Dental Update. 2002. https://pubmed.ncbi.nlm.nih.gov/12494560/