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JAMA Clinical Challenge
November 5, 2014

Recurrent Gingival and Oral Mucosal Lesions

Author Affiliations
  • 1Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia
JAMA. 2014;312(17):1794-1795. doi:10.1001/jama.2014.4298

A 57-year-old woman presents for evaluation of gingival “peeling” associated with pain and bleeding and white patches on the oral mucosa for 7 years. She reports no new medications, foods, or oral hygiene products. She reports no involvement of other cutaneous or mucosal surfaces and no family history of oral lesions. The lesions cause pain and difficulty brushing her teeth. She has a history of hypertension, hypothyroidism, type 2 diabetes, gastroesophageal reflux disease, and seasonal allergies. Her medications are valsartan-hydrochlorothiazide, levothyroxine sodium, metformin, insulin, and loratadine. Intraoral examination shows generalized erythema and sloughing of the maxillary and mandibular gingiva, without evidence of dental plaque, calculus, or both, and white striae (Wickham striae) affecting the gingiva and mucosa (Figure 1). Her physical examination is otherwise normal.