Witte laesies van het mondslijmvlies: denk ook buiten de kaders

White lesions of the buccal mucosa: think outside the box, too

A healthy, 49-year-old healthy woman presented at a maxillofacial surgery department with pain and a burning sensations in the mouth. She had experienced the discomfort for a year and it had made eating difficult. Clinical examination revealed white, plaque-like lesions on the buccal mucosa and tongue that could not be scraped off. A biopsy was taken by another health professional and oral lichen planus was diagnosed; treatment with triamcinolone dental paste and later clobetasol mouthwash followed. Neither treatment was sufficiently effective. A new biopsy confirmed a diagnosis of oral lichen sclerosus. Lichen sclerosus is a mucocutaneous condition commonly affecting the anogenital region, while the oral variant presents as white plaque. The differential diagnoses consisted of oral lichen planus, oral manifestations of systemic sclerosus (scleroderma) and leukoplakia. When other kinds of corticosteroid therapy are insufficiently effective, an intralesional injection of triamcinolone acetonide might be considered, which proved to be effective in this case.