Dermatology · Clinical photograph (oral mucosa)

Oral Lichen Planus (Wickham Striae)

White, lace-like (reticular) streaks on the inner cheek — Wickham striae of reticular oral lichen planus.

Inside of the left cheek showing fine white lacy streaks on pink mucosa
Classic white striations of non-erosive lichen planus on the left buccal mucosa.Image: Ian Furst, via Wikimedia Commons — CC BY-SA 4.0.

Written & reviewed by: Kinase Medical Team · Last reviewed: 30 September 2026 · Editorial policy

Key features

  • Reticular form: symmetrical white lace-like network (Wickham striae) on the buccal mucosa, often on both sides.
  • Erosive form: red areas with a whitish border and superficial ulcers, usually painful; gums and lips are commonly involved.
  • Skin lichen planus: pruritic, planar, polygonal, purple papules, often with Wickham striae on the surface.
  • Histology: band of inflammation at the dermal–epidermal junction with a 'saw-tooth' pattern.
  • Associated with chronic hepatitis C; lichenoid reactions can follow dental amalgam or certain drugs.
  • Rare malignant change to squamous cell carcinoma, mainly in the erosive form.

Differential diagnosis

Differential diagnosis of Oral Lichen Planus (Wickham Striae)
ConditionHow to tell it apart
LeukoplakiaA white patch not explained by another entity (lichen planus and candidiasis are excluded by definition); treated as precancerous until biopsied.
Oral candidiasisFuzzy white plaques, often in infants, the immunocompromised or after antibiotics/steroids; KOH shows pseudohyphae and budding yeasts (spores).

How it appears in NEET PG

Oral lesions are a common image format: a white lacy pattern on the buccal mucosa is asked as a diagnosis, or the question pairs skin 'P' features (purple, polygonal, pruritic, planar) with an association.

Frequently asked questions

What are Wickham striae?

Fine white lines forming a lace-like network on the surface of lichen planus lesions. On the oral mucosa they are the hallmark of the reticular form.

Is oral lichen planus premalignant?

It carries a small risk of oral squamous cell carcinoma, mainly in the erosive form, so persistent or changing lesions are followed up and biopsied.

Which infection is associated with lichen planus?

Chronic hepatitis C virus infection.

Sources

  1. DermNet — Oral lichen planus
  2. Robbins Basic Pathology (textbook)
  3. Harrison's Principles of Internal Medicine (textbook)
  4. Pathoma — Fundamentals of Pathology (review text)

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