Vulvar lichen simplex chronicus is a chronic inflammatory disease of the vulva characterized by intense itching and scratching. It is both a primary cause of vulvar pruritus and a secondary complication of any vulvar pruritic condition. Factors that can cause the initial pruritus include heat, excessive sweating, irritation from clothing or sanitary pads, topical products, candidiasis, contact dermatitis, and lichen sclerosus. Lichen simplex chronicus is more common in patients with seasonal allergies, asthma, or eczema. Differential diagnosis may include vulvovaginitis such as candidiasis, contact dermatitis, lichen sclerosus, vaginal atrophy, and vulvar intraepithelial lesions. Diagnosis is based on history and physical exam findings which may include erythematous, scaling, hypopigmented, hyperpigmented, or lichenified plaques, excoriations, and thickened leathery skin. Workup may also include a vaginal fungal culture and a vulvar biopsy. Treatment of lichen simplex chronicus involves strategies to stop the itch-scratch cycle, appropriate vulvar care and hygiene, and a medium- or high- potency topical corticosteroid ointment to treat the inflammation. Oral antipruritic medication may be recommended as needed for itching.