Primary lesion: ivory white, flat-topped papule which, on skin, will develop a keratotic follicular surface plug (delling).

Papules coalesce into atrophic plaques with a dull or glistening, smooth or wrinkled surface. Focal hemorrhage may occur in the plaque.

Painful vaginal mucosal lesions are atrophic and fragile. Lesions often hemorrhage, erode, and scar.