Vulvar lichen planus is an inflammatory condition that can affect the skin, oral mucosa, and vulvovaginal area. It can cause pain, soreness, itching, discharge, and lead to scarring. It is more common in perimenopausal and postmenopausal women, and patients with autoimmune disorders. The exact cause is unknown, but it may involve a dysfunction of cell-mediated immunity. Differential diagnosis includes but is not limited to vulvovaginitis such as candidiasis, contact dermatitis, lichen simplex chronicus, lichen sclerosus, vaginal atrophy, and vulvar intraepithelial lesions. Diagnosis is based on history and physical exam findings, and sometimes a vulvar biopsy or direct immunofluorescence to rule out other vulvar diseases. Physical exam findings can vary depending on the variant of lichen planus, but most commonly include white, reticulate, lacy fernlike striae. The oral cavity can also be involved. Treatment of lichen planus involves vulvar comfort care and hygiene, a high-potency topical corticosteroid ointment, and sometimes vaginal corticosteroids and vaginal dilators.