Etiology • Hypersensitivity to drugs including sulfasalazine, angiotensin-converting enzyme inhibitors, nonsteroidal anti-inflammatory drugs, β-blockers, gold, antimalarials, sulfonylurea compounds
• Contact hypersensitivity • Idiopathic reaction to dental restorations including amalgam,
composites, gold, other metals
Clinical Presentation • White striae or papules, as with lichen planus • Lesions may appear ulcerative with associated tenderness or
pain. • Most often in buccal mucosa and attached gingiva, but any site
may be involved
Diagnosis • Identification and elimination of causative substance • Biopsy of areas unresponsive to elimination strategy to demon-
strate characteristic keratosis and interface inflammation and associated changes
• Patch testing performed to confirm contact allergens
Differential Diagnosis • Lichen planus • Leukoplakia • Dysplasia/carcinoma
Treatment • Alternative drugs or material to be chosen • Topical corticosteroid applications • Topical tacrolimus applications
Prognosis • Good • Observation while lesions exist