Oral lichen planus — ORE Part 1 MCQ

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

ModerateOral Medicine and Oral PathologyOral lichen planusORE Part 1

A 56-year-old woman has bilateral white reticular striae on the buccal mucosa with intermittent soreness when eating spicy foods. The lesions have been present for six months and cannot be wiped away. There is no cervical lymphadenopathy. 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. The presentation of bilateral white reticular striae (Wickham's striae) on the buccal mucosa in a middle-aged woman is pathognomonic. The key discriminating features are: (1) reticular (lace-like) pattern rather than diffuse opacity, (2) non-scrapable (ruling out candidosis), (3) chronic 6-month duration with pain only on irritation (consistent with OLP's variable mild-to-severe presentation), and (4) bilateral symmetric distribution. Leukoedema is excluded because it is asymptomatic, presents as diffuse milky opacity rather than reticular striae, and disappears with mucosal stretching. Herpetic gingivostomatitis is acute with vesicles and systemic symptoms. Aphthous ulcers are discrete painful ulcers, not striated lesions. Candidosis is removable. Diagnosis of reticular OLP is usually clinical; biopsy is reserved for atypical presentations.

Reference: Oral lichen planus - an overview of aetiology and treatment. PubMed 41031689. 2024. https://pubmed.ncbi.nlm.nih.gov/41031689/