9. Buccal and palatal soreness

A 45-year-old Caucasian housewife had persistent oral soreness in both buccal (cheek) mucosae and palate for at least a year. She also had myalgia, arthralgia and a cutaneous lesion in her scalp but her medical history was otherwise clear. She had no known allergies. The patient was not on any medication apart from Prednisolone given by a physician for a short period. Her social history included no current tobacco use and no alcohol consumption.

Extra-oral examination revealed a scalp lesion showing hair loss in one site (Figure 1a) but otherwise no significant abnormalities, and specifically cervical lymph node enlargement, or cranial nerve, salivary or temporomandibular joint abnormalities. She had no pyrexia or signs of rheumatoid arthritis.

Oral examination revealed a dentition that was heavily restored. There was clinical evidence of some periodontal attachment loss and minimal pocketing. There was no obvious hyposalivation but in both buccal mucosae there were single ulcers. Each had a characteristic border with radiating white striae in a ‘hairbrush’ or ‘hedgehog’ pattern (Figure 1b). She also had bilateral palatal red lesions (Figure 1c).