Patient presents with complaints consistent with lichen sclerosus.  Symptoms include vulvar itching, burning, pain, dyspareunia, and dysuria.  Physical examination reveals porcelain-white, thin, and wrinkled skin affecting the vulva and perianal area, with evidence of erosions, fissures, or ecchymosis.  Differential diagnosis includes vulvovaginal atrophy, contact dermatitis, vitiligo, psoriasis, and squamous cell carcinoma.  Biopsy is performed to confirm the diagnosis of lichen sclerosus and rule out other conditions.  The patient's medical history is significant for (list relevant comorbidities such as autoimmune disorders, diabetes).  Family history is negativepositive for lichen sclerosus.  The patient is counseled on the chronic nature of the disease and the importance of long-term management.  Treatment plan includes topical corticosteroids, specifically clobetasol propionate ointment, applied twice daily for a specified period, followed by maintenance therapy.  Patient education provided regarding proper application, potential side effects of topical steroids, and the importance of follow-up appointments for monitoring disease progression and treatment efficacy.  ICD-10 code L90.0 is assigned.  Patient advised to avoid irritants, maintain proper hygiene, and use emollients for symptomatic relief.  Referral to a dermatologist may be considered for complex cases or if the response to treatment is suboptimal.