Vulvar lichen sclerosus: unraveling a clinical conundrum

Vulvar lichen sclerosus is a chronic, progressive inflammatory dermatosis that predominantly affects postmenopausal women but can also present in premenopausal individuals. It can cause significant scarring, leading to anatomical distortion, urinary dysfunction and impaired quality of life. The author describes a case of a woman in her late 30s with extensive vulvar involvement of lichen sclerosus, resulting in introital stenosis, dyspareunia and painful micturition. The patient was managed with a combination of topical steroids and systemic immunosuppressants, followed by surgical intervention using a Singapore flap for vaginal reconstruction. This case highlights the importance of early diagnosis, individualised treatment approaches and long-term follow-up in managing severe vulvar lichen sclerosus.