IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 17, Issue 9 Ver. 4 (September. 2018), PP 08-12 www.iosrjournals.org DOI: 10.9790/0853-1709040812 www.iosrjournals.org 8 | Page Extensive Oral Lichen Planus with Cutaneous Manifestations, A Case Report and Review of the Literature AA Hamid 1 , MT Peck 2 ,E Mosalleum 3 1 (Department of Oral and Maxillofacial Surgery& Medicine, Faculty of Dentistry, Al NeelainUniversity, Sudan) 2 (Department of Oral Medicine and Periodontics, Faculty of Dentistry, University of the Western Cape, South Africa) 3 (Department of Oral and Maxillofacial Pathology, Faculty of Dentistry, National Ribat University, Sudan) Corresponding author: Dr. AbdullahiAlhashimi Hamid -------------------------------------------------------------------------------------------------------------------------------------- Date of Submission: 28-08-2018 Date of acceptance: 11-09-2018 --------------------------------------------------------------------------------------------------------------------------------------- I. Case Report A fifty-two years old female referred to the oral medicine clinic, Faculty of Dentistry, University of the Western Cape complaining ofmouthburning that has been present for more than two years.The patient mentioned that she had been diagnosed with cutaneous lichen planus in 2010. She felt improvement of her skin condition since the diagnosis and discontinued follow up with no treatment. Her medical history revealed that she was hypertensive and on Pharmapress 10 mg and Radix 12.5 mg daily. She also reported a history of allergy to penicillin and sulphonomide. Extra-oral examination showed round brown- black pigmented macules and papules that were located in the lower back. There were neither lesions located on the flexor surfaces of the extremities nor associated itching with her back lesions (Fig.1). The intraoral examination revealed diffuse striated white patches that cannot be wiped away with gauze. The lesions (Fig. 2, 3, 4) were located bilaterally on the buccal mucosa, the ventral and dorsal surfaces of the tongue, palate, alveolar mucosa, and gingiva. Erosions were also noted on the upper left premolar and molar area (the patient was edentulous). Pigmented plaques were also noted within the white lesions of the buccal mucosa. The tongue was depapillated and glossy. The clinical differential diagnosis considered was lichen planus, lichenoid reaction and leukoplakia.Two incisional biopsies were performed from the left buccal mucosa and the palate (Fig. 5). The patient was prescribed Ibuprofen 400 mg three times per day for one week and requested to follow up after one week. The Biopsy result of the new oral lesions revealed licheanoid interface mucositis with a dense lymphocytic infiltrate in the superficial lamina propria. The previous biopsy from the skin revealed similar changes to the oral lesions in addition to sub-epithelial clefting (Fig. 6). The biopsy result of oral lesions revealed lichenoid interface mucositis with a dense lymphocytic infiltrate in the superficial lamina propria (Fig. 6). A previous biopsy of her skin revealed similar changes to the oral lesions in addition to sub-epithelial clefting. Based on the history, clinicopathological findings and after excluding other causes of licheanoid reaction, the diagnosis of oral lichen planus was established. The patient was prescribed Chlorohexidine mouth wash 0.12% to use two times per day and was advised to avoid spicy and acidic food. Topical Methylprednisolone Aceponate cream 1mg (15g Tube) was also prescribed three times daily and periodic follow up every three months was recommended.