Patients with lichen sclerosus et atrophicus (LS&A) complain of rough or dry patches of skin that are sometimes pruritic (Fig. 64-1). Genital lesions cause sexual dysfunction and dyspareunia. LS&A presents commonly as kraurosis vulvae, a keyhole or “figure 8” configuration of well-demarcated, hypopigmented, slightly atrophic patches around the vulva and perineum (Fig. 64-2). Skin atrophy is common; the surface is shiny and wrinkles like cigarette paper. Lesions on the penis are called balanitis xerotica obliterans.