Lichen sclerosus is a T-lymphocyte mediated chronic cutaneous disorder with predilection for the vulva. In prepubertal girls, lichen sclerosus presents as vulvar discomfort, pruritus, bruising/bleeding, discharge, dysuria, or painful defecation. Diagnosis and treatment of lichen sclerosus is of utmost importance in the prevention of complications such as scarring, adhesions, atrophy, or long-term sexual dysfunction. We discuss a case of a 4-year-old female with an atypical presentation of genital lichen sclerosus and a complicated biopsy.
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