A 35-year-old woman presents with pruritic, flat-topped, polygonal, violaceous papules over wrists and ankles. Wickham's striae are visible on the surface of papules. There are lacy white streaks in the buccal mucosa. What is the most likely diagnosis?

• A Psoriasis
• B Secondary syphilis
• C Discoid lupus erythematosus
• D Lichen planus ✓

Explanation

Lichen planus classically presents with the five Ps: pruritic, purple (violaceous), polygonal, plane (flat-topped) papules. The Wickham's striae (fine white lacy lines on the surface of papules) are pathognomonic and correspond histologically to areas of irregular acanthosis and compact hyperkeratosis overlying foci of Civatte body formation. Oral involvement with reticular white striations on the buccal mucosa occurs in 50-70% of cases and helps confirm the diagnosis.

Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.