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JAMA Clinical Challenge
November 23/30, 2011

Acute-Onset Reticulated White Lip

JAMA. 2011;306(20):2267-2268. doi:10.1001/jama.2011.1728

A 62-year old woman returns to your office with a diffuse, pruritic rash on her lips, palms, and upper back 2 weeks after starting lisinopril. Her medical history is significant only for hypertension. She has not had any dental restorative work, has never used intravenous drugs or had a blood transfusion, and has no known history of hepatitis C. On physical examination there are fine, white, intertwined, lacy reticulations on her lower lip, extending onto her buccal mucosa (Figure 1). Violaceous flat-topped papules and plaques are also apparent on her palms and upper back.