Most common symptom is pruritus,vulvodynia, pain, visible changes trhat may not be present.It can be contact dermatitis,fungal
infection,scabies, pediculosis capitis,or trichomoniasis.Chronic cause may be neoplasia or cancer, lichen sclerosus, allergic dermatitis, psoriasis,Crohn's disease, HPV.
Irritants can be adult or baby wipes,antiseptics, diapers, napkins, vaginal lubricants,vaginal hygiene products,antibacterials, soaps, shampoos, tea tree oil, podofilox. trichloroacetic acids,steroids, antimycotics,etc.Labial adhesions can occur in girls but should be observed only with topical estrogen unless there is urethral obstruction.Side effects are breast budding or vaginal bleeding.Estrogen also is given for those with vaginal atrophy.Clobetasol should be given to those with lichen sclerosus.To rule out carcinoma, biopsy must be done to hyperpigmented, exophytic, persistent and vascular lesions.Further evaluation should be done to those with biopsy-proven Paget's disease in genitourinary tracts, gastrointestinal tracts and breast areas.Long term maintenance therapy of cortisteroids ,methotrexate, cyclophosphamide,azathioprine etc is given to lichen planus