Question

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. Psoriasis
• B. Geographic tongue
• C. Lichen planus
• D. Candidiasis

Hint:

White lacy oral streaks plus nail pterygium point to one disease.

Answer 1

The Correct Option is C

Step 1: Two clues stand out. White lacy lesions in the mouth and a proximal nail fold that grows forward over the nail bed.
Step 2: White lacy streaks on the buccal mucosa are Wickham striae, the classic oral sign of lichen planus.
Step 3: The nail change described, where the proximal nail fold extends onto the nail bed, is pterygium of the nail. Pterygium formation is a typical nail finding of lichen planus.
Step 4: Both signs together point clearly to lichen planus. So option C is correct.
Step 5: Why the others are wrong. Psoriasis gives nail pitting and oil drop signs, not Wickham striae or nail pterygium. Geographic tongue shows shifting red map like patches, not white lace or nail change. Candidiasis gives removable white curd like patches, not lacy striae or pterygium.
Answer: Lichen planus.