Q. A 70-year-old woman comes to the physician’s office for vulvar itching for the past 3 months. She describes that the itching was mild initially but recently it has become intense and she is waking up in the middle of the night because of itching. She doesn’t have associated vaginal discharge or bleeding. She has used over-the-counter antifungal creams, anti-itch creams, and antihistamine tablets but none of them gave relief from symptoms. She denies using soap or lotion in that area. Her medical history shows that she is a known diabetic and hypertensive for the past 20 years and is on regular treatment. She reached menopause at the age of 52 years. Her temperature is 98.4°F (36.9°C), pulse is 87/min, blood pressure is 130/80 mmHg, and respirations are 15/min. Physical examination shows thickened reddish-brown plaques with some whitened areas over the vulvar skin. The affected skin shows increased markings. On palpation, the skin is leathery in consistency and non-tender. No lymphadenopathy is noted. What is the most likely diagnosis for this patient based on her clinical features?