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If the affected areas extend around the vulval and perianal skin a figure-of-eight pattern can be seen The affected skin is ivory-white, and may contain areas of telangiectases and purpura As a result of friction the skin often breaks down to form a red raw surface Other features occasionally seen include hyperkeratosis, vesicles, bullae, and ulcers Atrophy is a common feature and sometimes there may be marked shrinkage of the vulva, especially the clitoris and labia minora, and the vaginal introitus