Full Name

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* 1. Full Name

Contact Information (this information will only be used to contact you if you qualify to participate)

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* 2. Contact Information (this information will only be used to contact you if you qualify to participate)

How old are you

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* 3. How old are you

What is your date of birth?

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* 4. What is your date of birth?

Are you willing to travel to New York City for all 7 visits?

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* 5. Are you willing to travel to New York City for all 7 visits?

Are you currently pregnant, breastfeeding or planning on conceiving in the near future?

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* 6. Are you currently pregnant, breastfeeding or planning on conceiving in the near future?

Are you sexually active?

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* 7. Are you sexually active?

Are you currently using contraceptives?

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* 8. Are you currently using contraceptives?

If you are sexually active and do not use contraception, would you be willing to use contraception throughout the duration of the study? If you become pregnant, you must withdrawal from the study.

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* 9. If you are sexually active and do not use contraception, would you be willing to use contraception throughout the duration of the study? If you become pregnant, you must withdrawal from the study.

Have you been diagnosed with lichen sclerosus?

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* 10. Have you been diagnosed with lichen sclerosus?

Have you had a vulvar biopsy?

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* 11. Have you had a vulvar biopsy?

On a scale from 0-10, how do you rate the severity of your vulvar itching (0 being none, 10 being extreme).

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* 12. On a scale from 0-10, how do you rate the severity of your vulvar itching (0 being none, 10 being extreme).

Are you currently using any medications (systemic or topical) for your LS? If yes, please list all current treatments.

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* 13. Are you currently using any medications (systemic or topical) for your LS? If yes, please list all current treatments.

If you are currently treating your lichen sclerosus, are you willing to stop ALL treatments 4 weeks prior to your first visit and throughout the duration of the study? If you treat your lichen sclerosus 4 weeks before visit 1 or at any point during the study, you may be disqualified.

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* 14. If you are currently treating your lichen sclerosus, are you willing to stop ALL treatments 4 weeks prior to your first visit and throughout the duration of the study? If you treat your lichen sclerosus 4 weeks before visit 1 or at any point during the study, you may be disqualified.

Have you been diagnosed with other vulvar dermatologic conditions (lichen planus, lichen simplex chronicus, psoriasis, intraepithelial neoplasia, or carcinoma)? If yes, please explain.

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* 15. Have you been diagnosed with other vulvar dermatologic conditions (lichen planus, lichen simplex chronicus, psoriasis, intraepithelial neoplasia, or carcinoma)? If yes, please explain.

Do you have any severe medical conditions?

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* 16. Do you have any severe medical conditions?

Do you have a generalized infection (bacterial, fungal or viral), or obvious localized infections in the vulvar area?

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* 17. Do you have a generalized infection (bacterial, fungal or viral), or obvious localized infections in the vulvar area?

Do you have any ACTIVE sexually transmitted diseases?

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* 18. Do you have any ACTIVE sexually transmitted diseases?

Have you been diagnosed with an immunocompromising disease (lymphoma, AIDS, Wiskott-Aldrich Syndrome) or have an uncontrolled malignant disease?

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* 19. Have you been diagnosed with an immunocompromising disease (lymphoma, AIDS, Wiskott-Aldrich Syndrome) or have an uncontrolled malignant disease?

Do you have swollen lymph nodes (lymphadenopathy)?

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* 20. Do you have swollen lymph nodes (lymphadenopathy)?

Do you take systemic immunosuppressants?

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* 21. Do you take systemic immunosuppressants?

Have you taken or plan to take/use an investigational drug 4 weeks prior to the study or during the study?

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* 22. Have you taken or plan to take/use an investigational drug 4 weeks prior to the study or during the study?

Do you have a history of substance abuse?

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* 23. Do you have a history of substance abuse?

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