The clinical presentation of lichen planus of the vulva spans a spectrum from subtle, fine, reticulate papules to severe erosive disease accompanied by scarring and loss of the normal vulvar architecture. The end result may mimic other diseases. Because cutaneous lichen planus is usually absent and oral disease may be asymptomatic, the diagnosis can be easily missed unless the clinician has a high index of suspicion. Although treatment for vulvar lichen planus is suboptimal, a correct diagnosis may end the patient's search for an answer and help to prevent unnecessary procedures and therapies.