ACE Inhibitor Lichenoid Reaction — MFDS Part 1 MCQ

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ModerateHuman DiseaseACE Inhibitor Lichenoid ReactionMFDS Part 1

A 62-year-old patient develops predominantly unilateral reticular white striae with adjacent erythema of the buccal mucosa. Histopathological findings are compatible with an oral lichenoid reaction. Which medication in the patient's history is a recognised potential trigger?

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Correct answer: E — Enalapril

Enalapril is an angiotensin-converting enzyme inhibitor, a drug class reported as a potential cause of oral lichenoid reactions. These lesions can resemble idiopathic oral lichen planus but may be asymmetrical and can arise months after treatment begins. Improvement following withdrawal may support causality, but is variable; medication must not be stopped without liaison with the prescriber. Nicorandil is particularly associated with persistent oral ulceration, while alendronic acid may cause mucosal injury and is relevant to medication-related osteonecrosis of the jaw. Inhaled beclometasone predisposes to oral candidosis, and liquid ferrous sulfate can cause extrinsic dental staining. These alternatives do not provide the characteristic association tested here.

Reference: Firth NA, Reade PC. Angiotensin-converting enzyme inhibitors implicated in oral mucosal lichenoid reactions. Oral Surgery, Oral Medicine, and Oral Pathology. 1989;67(1):41–44. https://pubmed.ncbi.nlm.nih.gov/2536146/