Background: Oral lichen planus (OLP) is a chronic immune-mediated mucocutaneous disorder affecting approximately 0.5–2% of the population and is recognized as a potentially malignant disorder. The reticular variant is the most common clinical form and is characterized by the presence of Wickham’s striae. Psychological stress has been implicated as an important precipitating and exacerbating factor in the pathogenesis of OLP. Case Presentation: A 38-year-old female presented with a 10-year history of asymptomatic white striations on the left buccal mucosa. Clinical examination revealed a well-defined whitish-grey lesion measuring approximately 3.0 × 2.0 cm, exhibiting fine, lace-like reticular striae characteristic of Wickham’s striae. The lesion was non-tender, non-indurated, and showed no evidence of ulceration, erosion, or surrounding erythema. The patient reported a prolonged history of chronic psychosocial stress. An incisional biopsy was performed, and histopathological examination demonstrated parakeratinized stratified squamous epithelium with focal epithelial-connective tissue separation and a dense juxtaepithelial lymphocytic inflammatory infiltrate, confirming the diagnosis of reticular oral lichen planus.
Discussion: The clinical and histopathological findings were consistent with classical reticular OLP. Chronic psychological stress may have contributed to disease initiation and persistence through neuroendocrine-immune interactions and immune dysregulation. As the lesion was asymptomatic, conservative management with patient education, stress reduction measures, and periodic follow-up was advised. Conclusion: This case highlights the importance of comprehensive clinical examination and histopathological confirmation in the diagnosis of oral white lesions. Early recognition of OLP, assessment of potential risk factors such as psychological stress, and long-term surveillance are essential because of its potential for malignant transformation.