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Vulval lichen sclerosus — DRCOG MCQ

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ModerateGynaecologyVulval lichen sclerosusDRCOG

A 29-year-old woman has vulval itching for 6 months with soreness during sex. Examination shows pale thin plaques with fissuring in a figure-of-eight pattern around the vulva and perianal skin. What is the most likely diagnosis?

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Correct answer: C — Lichen sclerosus

Chronic vulval itch with pale atrophic plaques and fissuring in a figure-of-eight distribution suggests lichen sclerosus. Candida can cause itch but would not cause the characteristic white plaques and architectural change. The pearl is that suspected lichen sclerosus needs potent topical steroid treatment and follow-up because of scarring and malignancy risk.

Reference: BAD guideline for lichen sclerosus; NICE CKS