4. A 56-year-old woman presented to your clinic with vulvar pruritus and a burning sensation of 6 months’ duration. She had used a topical antibiotic and hydrocortisone cream 1% without relief. On physical examination, a red, irregular plaque is noted on the vestibule. The most likely diagnosis is:
a. Behçet disease
b. extramammary Paget disease
c. pemphigus vulgaris
d. plasma cell vulvitis
e. vulvodynia