Vulval lichen sclerosus — DRCOG MCQ

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ModerateGynaecologyVulval lichen sclerosusDRCOG

A 66-year-old woman has vulval itching and soreness. Examination shows pale thin plaques with fissuring around the vulva and perianal skin. There is no vaginal discharge. What is the most likely diagnosis?

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Correct answer: C — Vulval lichen sclerosus

White atrophic vulval plaques with fissuring and pruritus in an older woman are typical of lichen sclerosus. Herpes usually causes painful vesicles or ulcers. Bartholin cyst causes a unilateral posterior introitus swelling. Lichen sclerosus requires potent topical corticosteroids and follow-up because of scarring and small malignancy risk.

Reference: NICE CKS lichen sclerosus; British Association of Dermatologists guideline