Approach to vulvar skin disorders Quiz: Ace Your Exams
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A 48-year-old woman presents to her OB-GYN for evaluation of two months of vulvar burning and irritation and dyspareunia. She also notes ulcers in her mouth that cause discomfort while eating. She has not used any new soaps, detergents, or body products. She has regular menstrual cycles and is in a monogamous relationship with her partner, who underwent vasectomy for contraception. Medical history is notable for autoimmune hypothyroidism managed with levothyroxine and low-grade squamous intraepithelial lesions (LSIL) on routine cervical cancer screening at age 24 that resolved spontaneously. Cervical cancer screening has been normal since that time, including her most recent test 2 years ago. Vital signs are within normal limits. She appears well and is in no acute distress. On exam, multiple erythematous erosions are noted on the labia minora, vaginal vestibule, and oral mucosa. White, lacy striae are seen surrounding the erosions on the vulva, buccal mucosa, and palate. Which of the following is the most likely diagnosis?
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