Fig. 1.

A: Three months after the flap surgery, the hairy darker pigmented skin of the flap (arrowhead) is normal corresponding to its donor site (arrowhead). The hairless vulvar skin exhibits clinical signs of lichen sclerosus. B: Eight years later, the lichen of the hairless vulva skin had progressed involving parts of the anus as well. The hairy skin island (arrow) is completely diseased, whereas the skin of the donor region (arrowhead) remains normal. Inset: Microscopic features of LS on the hairy skin of the cutaneous flap: thinning of the epidermis with loss of the rete ridges and dermal hyalinisation (*) involving the superficial reticular dermis, accompanied by scattered infiltration of lymphocytes.