The patient denies pain so vulvodynia is excluded. The differential diagnosis varies whether the lesions are papular or patch/plaque.

Papular lesions may be
Cysts and Syringoma are smooth dermal lesions while condyloma and BP are epidermal.

Although lesions of BP are characterized by a generally smooth surface and reddish brownish color, BP and condyloma cannot be differentiated with absolute certainty based on the clinical examination alone. Syringoma and cysts are both usually multiple and uniformly distributed. Cysts are more likely to be yellowish and round.

Patch lesions may represent
while plaque lesions may represent

Lesions of LS are characteristically white with frequent purpura and telangiectasia while lesions of LP are red. Unlike LP involving the penis which presents as papules, LP of the female genitalia presents as red patches. Both disorders involve the labia minora and both may develop erosions. Malignant degeneration is more frequent in lesions of LS. Patients with genital LS may have extragenital lesions, whereas patients with vulvar LP may have oral LP lesions and occasionally lichen planopilaris of the scalp.

Vulvovaginitis may be caused by irritant and/or allergic contact dermatitis as well as Candidal or bacterial infection. Detailed history and complete genital examination, in addition to patch testing and/or cultures, often lead to an accurate diagnosis.

EMPD lesions are generally brightly red and often eroded, and as a result misdiagnosed frequently as Candidiasis. Vulvar SCC in situ may be misdiagnosed as LSC , especially in patients who experience pruritus and admit to scratching which may lead to superimposed lichenification. A high index of suspicion is required for the early diagnosis of EMPD and SCC.

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