Hyperpigmented papules over labium majus: A venereal cause or something else

A 42‐year‐old female presented with a history of skin lesions over the right side labium majus for 3 months. She noticed the lesions over the right side labium majus 3 months back which gradually increased in size and number. Mild itching was present. History of any genital lesion was not present in husband. On examination, hyperpigmented, soft papules over the right side labium majus were seen and few lesions were showing umbilication and white scale [Figure 1]. Mucosal examination was normal. Serological test resul ts for human immunodeficiency virus and VDRL were negative. Examination of the husband revealed no genital lesions. Based on clinical features, differential diagnosis of molluscum contagiosum and bowenoid papulosis was made. Dermoscopy of the lesions showed Wickham striae in globular and reticular pattern in the center, with areas of bluish‐gray dots and globules, few out‐of‐focus vessels, and purple‐gray background suggestive of LP [Figure 2]. Histopathology of the lesion showed acanthosis , hyperkeratosis, and prominent granular layer. The dermoepidermal junction showed dense lichenoid lymphocytic infiltrate along with melanophages in the superficial dermis with artifactual cleft formation between epidermis and papillary dermis [Figure 3]. Based on dermoscopy and histopathological findings, final diagnosis of LP was made. The patient was started on topical clobetasol propionate 0.05% gel twice daily, and after 3 weeks of treatment, significant improvement was seen [Figure 4].