Which presentation is most indicative of erosive lichen planus?

The presentation most indicative of erosive lichen planus is characterized by the presence of white patches, also known as Wickham's striae, which typically appear on the cheeks and mucosal surfaces. Erosive lichen planus often manifests with a combination of these white patches and a more erosive, painful component that can affect the integrity of the mucosal tissues. This condition is distinct due to its unique clinical appearance, which includes white reticular striae along with areas of ulceration or erosion.

In contrast, other choices do not specifically convey the classic findings of erosive lichen planus. Redness of the gums may suggest inflammation or other conditions, while dark spots on the tongue do not specifically point to lichen planus and, instead, might be related to other tongue pathologies. Painful ulcers can occur in various conditions, including erosive lichen planus, but they are not as definitive without the accompanying white patches that characterize the condition. Therefore, the presence of white patches on the cheeks is the hallmark feature that aligns most closely with erosive lichen planus.