Ob-Gyn questions? Ask a gynecologist online.
What are you using as "topical hrt". Estrogen? Progesterone? Why? Lichen sclerosis cannot be diagnosed without biopsy. You could have several conditions.
1. Allergy to the estrace cream, try a prescription for vagifem instead
2. Allergic reaction to something else, a pad or a soap
3. LS which can only be diagnosed by biopsy
It sounds like you should see another gyn Dr