A 78-year-old Caucasian woman presented with a fi ve-year history of pruritic vulvar and perianal lesions. Previous treatment with topical corticosteroids and antifungal agents had been ineffective. Clinical examination showed well-demarcated, erythematous, eczema-like plaques in the vulvar and perianal region (Figure 1 ). The patient was otherwise healthy, and blood tests were within normal limits.