A 52-year-old woman was bothered by burning pain in the genital area. Her husband noted discoloration of the skin in the same location.
Key point: The shiny white and atrophic skin involving the vulva and perirectal skin is nearly pathognomonic for lichen sclerosus et atrophicus (LSA). This inflammatory disorder of unknown etiology gradually increases in intensity. Although LSA may resolve spontaneously in prepubertal patients, it only rarely does so in adults.
Treatment: Application of ultrapotent corticosteroids (eg, clobetasol, halobetasol) is indicated.
Note: Left untreated over an extended period (years), there is a small risk that squamous cell carcinoma will develop within affected skin. Periodic reassessment is important.