Pictorial Case Study

THE CASE

A 50-year-old man presented with erosions on his buccal mucosa. Examination revealed lacy, reticulated streaks on cheeks, gums and lips. He also had purplish pigmented lesions on his arms. He was otherwise well. What are the diagnosis, management and differential diagnoses?

Diagnosis and management

The patient has oral lichen planus (LP). Treatment is not usually necessary in painless oral LP. He was given general advice about oral hygiene. Mouthwashes and a variety of topical steroid preparations may be useful. Stress, chilli-based spicy foods, citrus fruit and strongly flavoured toothpastes can aggravate symptoms. He was informed that oral LP is self-limiting but can recur after years.

Possible different diagnoses

- Leukoplakia.

- Oral candidiasis.

- Carcinoma of the mouth.

Differential diagnosis

Oral candidiasis

- White curd-like plaques adherent to the buccal mucosa.

- Underlying epithelium is inflamed and friable.

- Associated with use of antibiotics, topical, inhaled or oral steroid therapy and diabetes.

- Painful.

Contributed by Dr Vasa Gnanapragasam, a GP in Sutton, Surrey.

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