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A 62-year-old woman came to the office complaining of a one-year history of intermittent, intense vulvar itching. OTC topical anesthetic and cooling agents provided only temporary symptomatic relief. Her medical history was significant for hypertension and coronary artery disease, which were currently stable on metoprolol and hydrochlorothiazide. The patient reported no history of sexually transmitted diseases. Although she had an occasional urinary tract infection, she denied any recent dysuria or frequency and did not correlate her vulvar symptoms with any urinary abnormality. Examination revealed hypopigmentation and atrophy of the labia. There were no erosions or papules.