Question:medium
A young lady presents with white lacy lesions in the oral cavity and her proximal nail fold has extended onto the nail bed. What is the likely diagnosis?
A young lady presents with white lacy lesions in the oral cavity and her proximal nail fold has extended onto the nail bed. What is the likely diagnosis?
Show Hint
White lacy oral streaks plus nail pterygium point to one disease.
Updated On: Jun 24, 2026
- Psoriasis
- Geographic tongue
- Lichen planus
- Candidiasis
Show Solution
The Correct Option is C
Solution and Explanation
Break the case into its two signature signs. First, the mouth shows white lacy patterns. Second, the nail shows the proximal fold creeping forward onto the nail bed.
The lacy white network on oral mucosa has a name, Wickham striae, and it is the textbook oral mark of lichen planus. The nail finding, where the cuticle and proximal fold fuse onto the bed, is pterygium, again a known nail feature of lichen planus. When both appear in one patient, the diagnosis is lichen planus.
Test the distractors. Psoriasis would give pitted nails and oil drop discolouration plus silvery scaly plaques, not lacy oral streaks or pterygium. Geographic tongue produces moving red bald patches with white borders on the tongue only, with no nail link. Oral candidiasis makes soft white curd that wipes off, not fixed lacy lines, and it does not cause pterygium.
So the combination of Wickham striae and nail pterygium settles it as lichen planus.
\[\boxed{\text{Lichen planus}}\]
The lacy white network on oral mucosa has a name, Wickham striae, and it is the textbook oral mark of lichen planus. The nail finding, where the cuticle and proximal fold fuse onto the bed, is pterygium, again a known nail feature of lichen planus. When both appear in one patient, the diagnosis is lichen planus.
Test the distractors. Psoriasis would give pitted nails and oil drop discolouration plus silvery scaly plaques, not lacy oral streaks or pterygium. Geographic tongue produces moving red bald patches with white borders on the tongue only, with no nail link. Oral candidiasis makes soft white curd that wipes off, not fixed lacy lines, and it does not cause pterygium.
So the combination of Wickham striae and nail pterygium settles it as lichen planus.
\[\boxed{\text{Lichen planus}}\]
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