Pruritic lichenoid lesions on the vulva of an 11-year-old girl

An 11-year-old premenarcheal Taiwanese girl presented with a 2year history of itchy papules on the external genitalia. The itching was generally mild and intermittent but was aggravated by heat or during hot weather. These lesions increased gradually and had poor response to topical corticosteroid, antibiotic, or antifungal therapy. Examination revealed numerous, coalescing, 1-mm to 2mm, slightly erythematous lichenoid papules on the labia majora. Many papules were surmounted by tiny white milia (Figure 1). There was no extragenital lesion. She denied family history, prior local trauma, or vesiculobullous disease. A skin biopsy specimen was obtained from yellow-white papules on the left labia majora. The histopathological evaluation showed numerous short cords or coma-shaped cords and ductal structures lined by cuboidal epithelial cells embedded in a sclerotic stroma in the upper and