Erosive oral lichen planus — SCE Dermatology MCQ

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ModerateGenito-urinary disorders and oral medicineErosive oral lichen planusSCE Dermatology

A 49-year-old woman has painful bilateral buccal erosions surrounded by white lacy streaks. Symptoms worsen with spicy food, and there are violaceous flat-topped papules on the wrists. There is no genital ulceration or ocular inflammation. What is the most likely diagnosis?

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Correct answer: E — Erosive oral lichen planus with interface mucositis

Explanation lettering: D = shown as A · A = shown as B · B = shown as C · C = shown as D

E is correct. Painful bilateral buccal erosions bordered by white lacy Wickham striae, together with violaceous flat-topped wrist papules, are the characteristic mucocutaneous phenotype of erosive oral lichen planus. Histology shows interface mucositis with basal-cell degeneration and a band-like lymphocytic infiltrate. A causes fragile bullae and widespread erosions with suprabasal acantholysis rather than reticular white striae. B produces white plaques or erythematous candidiasis with fungal hyphae. C causes recurrent aphthous-type ulcers and requires a different systemic context. D generally presents as a persistent focal white or erythroplakic lesion with epithelial atypia rather than a symmetrical inflammatory pattern. Persistent erosive disease requires symptom control and surveillance for malignant change.

Reference: BAD oral lichen planus information: https://www.bad.org.uk/pils/oral-lichen-planus