Title: An atypical oral presentation of pityriasis lichenoides chronica
Abstract:
A 54 year old female presented to the Oral Surgery department following a two-week-wait referral made by her GP. She presented with an isolated 2x2cm non-healing erythematous ulcer of the right posterior soft palate. This had been present for approximately 5 weeks duration and appeared suspicious for squamous cell carcinoma (SCC). Following an incisional biopsy which showed no malignancy or dysplasia, the patient disclosed that she had consulted a dermatologist regarding skin lesions and been diagnosed with a condition called Pityriasis Lichenoides Chronica (PLC).
Pityriasis Lichenoides (PL) is a spectrum of rare inflammatory idiopathic dermatological conditions thought to be T-cell mediated. PLC manifests gradually as very small red-brown maculopapules mainly affecting the trunk and extremities. The lesions can last several weeks before spontaneous regression, with long periods of remission as the course of eruptions occurs over many years prior to self-resolution. The oral ulcer was monitored including clinical photography, and symptomatic relief achieved with the use of Benzydamine Hydrochloride mouth spray. As could be predicted, the ulcer regressed several months following the biopsy, leaving behind an area of hypopigmentation. Following a period of remission, it has since recurred as a small ulcer 2 years later and the patient continues to attend regular 6-12 monthly review appointments. She is no longer being followed-up by the consultant dermatologist.
This case report illustrates the importance of maintaining a flexible perspective when determining the differential diagnosis of lesions which are phenotypically similar to SCCs, ensuring the full clinical context and patient-specific factors have been considered.
