A clinician inquired about a 51-year-old female with a complaint of chronic vulvar itching. She had never had an abnormal pap smear result and has tried multiple over-the-counter medications for vaginal yeast infections and generic ‘itch’ medication with relief.

Examination showed a whitish/silver, thinned mucosa of the labia majora and labia minora. It was noted to extend in an hourglass pattern to encircle the anus.

Examination and symptoms were consistent with lichen sclerosus et atrophicus. This is a chronic inflammatory condition affecting the underlying dermal layer. The exact cause is not known. Successful treatment ideally begins early in the course of the condition and consists of daily application of high-potency steroid cream.

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Sherril Sego, FNP-C, DNP is a primary-care nurse practitioner at the Department of Veterans Affairs Medical Center in Kansas City, Mo.

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