We present a 34-year-old woman with 3-year history of a hypopigmented hyperkeratotic area on the medial aspect of the right labia minora. Her medical history was significant for receding gums status post grafting and no other oral sores. The patient reported history of molluscum contagiosum treated with TCA in the area of the lesion. Following TCA treatment, the area remained irritated, and a biopsy was performed which confirmed verrucous keratosis. She was then treated with imiquimod with no change in lesion or irritative symptoms. She was subsequently trialed with Vaseline barrier daily and medium potency local steroid ointment daily without improvement. Given persistent irritation the lesion was excised (Figure 1). Complete healing and resolution of symptoms was noted at 2-month return (Figure 2).

Vulvar verrucous keratosis has not been reported in the literature on search of PubMed, Cochran, Scopus, Covidence, Google, Bing or Yahoo. Verrucous keratosis is a benign skin condition, often confused with seborrheic keratosis. Diagnosis is based on histopathology. While benign, verrucous keratosis comprises a histologic spectrum from hyperkeratosis to carcinoma [1].