An 83-year-old woman with urinary incontinence was referred to our clinic with a 2-year history of pruritic and painful lesions in the genital and suprapubic area. Repeated cycles of topical corticosteroid therapy resulted in a minimal and transitory response. The patient also reported a constant burning sensation that she treated with several daily applications of topical benzocaine. Dermatologic examination of the vulva, mons pubis, inner thighs, and suprapubic area revealed multiple, flesh-colored to erythematous violaceous papules, nodules, and plaques, some of which displayed superficial erosions (Figure 1). Culture of the lesional tissue did not demonstrate clinically significant bacterial or fungal pathogens. A skin biopsy specimen was obtained for histologic analysis (Figure 2).