Derm Dx: White Patches on the Buccal Mucosa - Clinical Advisor

Derm Dx: White Patches on the Buccal Mucosa

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A 32-year old man is referred by his dentist for evaluation of white-colored patches on his buccal mucosa. He denies experiencing burning or pain. The patient’s medical history is negative for systemic disease. He smokes 1 pack of cigarettes per day and drinks several beers per week. He admits to occasional marijuana use. Full-body skin examination is unremarkable except for a few papules on his ankle that he attributes to insect bites.

Can you diagnose this condition?

Lichen planus is a chronic inflammatory condition that can affect the skin and mucous membranes. Oral lichen planus (OLP) can manifest in a variety of forms including atrophic, bullous, erosive, plaque-like, and reticular.1 Wickham striae — slightly raised, fine, white...

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Lichen planus is a chronic inflammatory condition that can affect the skin and mucous membranes. Oral lichen planus (OLP) can manifest in a variety of forms including atrophic, bullous, erosive, plaque-like, and reticular.1 Wickham striae — slightly raised, fine, white or gray lines arranged in a lacy or web-like pattern — are often associated with OLP.2 These can present on the inside of the cheeks, tongue, and gums. The pathogenesis of OLP occurs as a consequence of autocytoxic T-cells that trigger apoptosis, or cell death, within the oral epithelium. Factors that may precipitate this include allergic-mediated reactions, hepatitis C infection, and autoimmune disorders.3

Diagnosis of OLP often can be made on clinical findings alone with bilateral interlacing white striae considered pathognomonic. The condition may be asymptomatic or associated with pain and burning. Approximately 25% of cases present without skin findings.4 No specific treatment for OLP exists; potent topical steroids often are used as first-line therapy to provide symptomatic relief.

Myers Manga is a physician assistant student at Arcadia University, in Glenside, Pennsylvania; and Stephen Schleicher, MD, is director of the DermDox Center for Dermatology, as well as an associate professor of medicine at Commonwealth Medical College and a clinical instructor of dermatology at Arcadia University and Kings College.

References

1. Torti DC, Jorizzo JL, McCarty MA. Oral lichen planus: A case series with emphasis on therapy. Arch Dermatol. 2007;143(4):511–515.

2. Sachdeva S, Sachdeva S, Kapoor P. Wickham striae: etiopathogenensis and clinical significance. Indian J Dermatol. 2011;56(4):442–443.

3. Lavanya N, Jayanthi P, Rao UK, Ranganathan K. Oral lichen planus: an update on pathogenesis and treatment. J Oral Maxillofac Pathol. 2011;15(2):127–132.

4. Sankar V, Noujeim M. Oral manifestations of autoimmune and connective tissue disorders. Atlas Oral Maxillofac Surg Clin North Am. 2017;25(2):113-126.

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