Vulval lichen sclerosus — DRCOG MCQ

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HardGynaecologyVulval lichen sclerosusDRCOG

A 58-year-old woman has severe vulval itching and soreness. Examination shows pale thin plaques around the vulva with fissuring and loss of architecture. There is no vaginal discharge. What is the most likely diagnosis?

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Correct answer: C — Vulval lichen sclerosus

Pale plaques, fissuring and architectural change in a postmenopausal woman are typical of lichen sclerosus. Candidiasis causes itch but usually has discharge and erythema rather than scarring white plaques. Atrophic vaginitis may cause dryness and dyspareunia but does not usually cause vulval architectural loss. The pearl is that lichen sclerosus needs potent topical steroid treatment and surveillance for vulval cancer risk.

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