A 20-year-old female presented to the dermatology OPD with skin lesions which were itchy, violaceous, shiny flat topped, polygonal papules of various sizes on flexor surface of wrist. These when viewed under a magnifying lens, surface of the lens showed ceain streaks which were enhanced by putting a drop of mineral oil on the lesions. Koebner’s phenomena was present. On examination, some lesions were observed in the oral mucosa along with erosive lesions on tongue. Nails showed thinning and distal splitting of nail plates, longitudinal ridging and pterygium.
Correct Answer: Lichen planus
Description: This is a case of lichen planus 2ND image shows lacy reticular striae (Wickham striae) seen on dermatoscopy of a lesion. 3rd image shows the classical and pathognomic white reticulate lacey pattern on buccal mucosa. Lichen planus is a disease that can affect the skin and any lining mucosa. This could be the oral, esophageal, vaginal mucosa as well as the skin. Often, it is found only in the oral cavity. Lichen planus can appear in the mouth in several different patterns. The reticular pattern is commonly found on the cheeks as lacy web-like, white threads that are slightly raised. These lines are sometimes referred to as Wickham's Striae. Most common sites are the flexors of wrist and shin and lower back. In lichenoid eruption, Wickham's striae are absent and occurs on sun-exposed areas. In lichen nitidus, the lesions are tiny, multiple, round/flat skin coloured shiny papules. In DLE, photosensitivity of the lesions is present.
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