Vulvar lichen sclerosus is a chronic dermatologic condition that can cause pruritus and pain of the anogenital skin, and leads to scarring. It can sometimes be asymptomatic. It is more common in prepubertal girls and postmenopausal women. The exact cause is unknown, but may include a combination of autoimmune processes and genetic factors. Differential diagnosis includes but is not limited to vulvovaginitis such as candidiasis, contact dermatitis, lichen simplex chronicus, vaginal atrophy, and vulvar intraepithelial lesions. Diagnosis is based on history, physical exam findings, and often a vulvar biopsy to exclude other vulvar diseases. Physical findings may include thinned, whitened, and crinkled skin, porcelain-white papules and plaques, areas of ecchymosis or purpura, narrowing of the introitus, fusion of the labia minora, phimosis of the clitoral hood, and fissures. Treatment of lichen sclerosus involves a medium- or high- potency topical corticosteroid ointment, initially with more frequent dosing, and then tapered to a maintenance regimen.