JAMA Clinical Challenge |

Acute-Onset Reticulated White Lip

Jeffery B. Shackelton, MD; Joseph C. English, MD
JAMA. 2011;306(20):2267-2268. doi:10.1001/jama.2011.1728.
Text Size: A A A
Published online


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.

Figures in this Article



Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
First page PDF preview


Place holder to copy figure label and caption
Figure 1. Reticulated White Striae on the Lower Lip
Graphic Jump Location
Place holder to copy figure label and caption
Figure 2. Skin Biopsy Demonstrating Histologic Features of Lichen Planus
Graphic Jump Location

Biopsy taken from a lesion on the patient's upper back (hematoxylin-eosin, original magnification ×10).



Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 2

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles