64 yr old G2P2, 12 month history of severe .... - azsmu

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64 year old G2P2 presents with a 12 month history of severe vulvar pruritus. She has applied multiple over-the counter topical therapies without improvement. She has no significant vaginal discharge. She is currently on oral estrogen therapy for osteoporosis. She has severe introital dysparenunia and has stopped having intercourse because of pain. Her past medical history is signigicant for allergic rhinitis and hypertension. On pelvic examination, the external genitalia show loss of the labia minora with resorption of the clitoris (phimosis). The vulvar skin appears thin and pale and involves the perineal area. No ulcerations are present. The vagina is mildly atrophic, but appears uninvolved. Which of the following is the most likely diagnosis in this patient?

1. Squamos cell hyperplasia
2. Lichen sclerosus
3. Lichen planus
4. Candidasis
5. Vulvar cancer

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