"The Lichens"

Vulvar lichen sclerosus (LS) and lichen planus (LP) are chronic inflammatory dermatoses that significantly impair quality of life through pruritus, pain, sexual dysfunction, and risk of scarring or malignancy. Although they share lichenoid histopathologic features, LS primarily affects keratinized skin, while LP commonly involves mucosal surfaces and may present with erosive, papulosquamous, or hypertrophic variants. Disease underrecognition often delays diagnosis and treatment. This review summarizes the epidemiology, pathophysiology, clinical presentation, histopathology, and management of vulvar LS and LP, highlighting distinguishing features, areas of diagnostic overlap, and best practices to optimize outcomes and prevent long-term complications.