A 55-year-old woman presents with a longstanding history of multiple ivory-white atrophic patches involving the vulvar and perianal area that appear in a “figure-eight” (bidirectional) pattern. Superficial telangiectases are present. The involved areas are pruritic and the patient complains of dysuria, dyspareunia, and pain with defecation. In addition, the patient has several ivory-white papules coalescing into atrophic plaques on her upper back.
The most likely diagnosis is
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Lichen planus
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Scleroderma
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Vitiligo
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Discoid lupus erythematosus
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Lichen sclerosus
Answer on page 713
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