Vulvar vestibular papillomatosis: A diagnostic conundrum

Vulvar vestibular papillomatosis (VP) is considered a normal anatomical variant of the vulva. We present a 19-year-old girl with a history of "small itchy growths" on the vulva for 2 months without any associated discharge. These lesions were causing significant anxiety to the patient. Cutaneous examination revealed multiple, uniformly arranged, skin-colored, monomorphic micropapillae on the inner aspect of the labia minora. Biopsy showed mucosal hyperplasia with papillomatosis and loosely arranged subdermal tissue, no koilocytes were spotted. The diagnosis of vulvar VP was made. We want to highlight this clinical entity as most dermatologists are not familiar with this benign condition and easily confuse it with genital warts. This inexperience may result in unnecessary investigations causing psychological discomfort to the patient. We herein present such a case which brings out the diagnostic dilemma.

Case series of rare nonvenereal vulvar dermatoses

Nonvenereal vulvar diseases such as syringoma and vestibular papillomatosis can be difficult to differentiate from genital warts. Misdiagnosis of these conditions can lead to improper treatment without significant improvement and prolonged suffering. Histopathology may differentiate these conditions from sexually transmitted diseases and help in appropriate treatment. Here, we present case series of four rare vulvar diseases.

Benign "lumps and bumps" of the vulva: A review

Vulvar dermatology represents a challenge for many providers. Given that the vulva is both a gynecologic and dermatologic organ, patients with cutaneous lesions involving the vulva may present to primary care, gynecology, or dermatology. Particularly within dermatology, the vulva remains understudied, which can lead to anxiety among providers regarding appropriate next steps in the diagnosis and management of vulvar lesions. Thus, the purpose of this review is to highlight commonly encountered anatomic variants and benign neoplasms of the vulva, distinguish them from key pathologic mimickers, and provide guidance to practicing dermatologists on what may constitute normal vulvar variations.

[Vulva anatomopathological peculiarities]

The vulva is the transition zone between the skin and the lower genital tract. As such, it presents histological specificities, comprises physiological modifications which are specific to it and is characterized by particular artifacts. Knowledge of them prevents many questions or even diagnostic errors.

[Vulvar inflammatory dermatoses]

Vulvar skin disease is a common reason for consultation. The vulva, like the rest of the skin, can be affected by numerous diseases of various etiologies, but its particular anatomic and physiologic characteristics create additional diagnostic and therapeutic difficulties. The study of vulvar disease is emerging as a new branch of dermatology. In this article, we examine the characteristics of the normal vulva, and perform a brief, structured review of vulvar inflammatory dermatoses, which comprise a heterogeneous group of diseases in which a broad, multidisciplinary approach is essential.

Human papillomavirus with co-existing vulvar vestibulitis syndrome and vestibular papillomatosis

OBJECTIVE

The role of HPV infection in cases of vulvar papillomatosis and vulvar vestibulitis syndrome is still unclear and data from the literature is controversial. In this study we intended to investigate the prevalence of viral infection, with a multidisciplinary approach, in cases with a co-existence of the two patterns.

METHOD

Sixteen consecutive cases with diagnosis of vulvar vestibulitis syndrome and co-existence of vestibular papillomatosis were enrolled in the study and investigated by the means of vulvar cytology, vulvoscopy, histology, ViraPap and Polymerase Chain Reaction.

RESULT

Cytology, vulvoscopy and histology did not demonstrate suitable accuracy for the diagnosis. Viral DNA identification revealed two (12.50%) positive cases using PCR and one (6.25%) positive case with ViraPap.

CONCLUSION

The results of the present investigation indicate that even in cases of co-existing vulvar papillomatosis and severe vulvar vestibulitis syndrome, the prevalence of HPV infection is too low to be considered causal.

Vulvodynia and its differential diagnoses

Vulvodynia is the symptom of chronic vulvar discomfort characterized by the patient's complaint of burning and sometimes stinging or rawness. It is a multifactorial problem in which no single etiologic factor or pathogenetic mechanism has been identified. Patients with vulvodynia exhibit several features of neuropathic pain, such as allodynia, hyperalgesia, dysesthesia, and chronic pain in the absence of ongoing noxious stimuli. The treatment of vulvodynia has, in the past, focused on irradicating suspected infective causes, such as human papillomavirus, with varying success. More recently, approaches mimicking the therapy of other chronic pain syndromes, eg, the use of low-dose antidepressants, has met with some success. There is a need for uniformity in terminology and therapeutic approach, epidemiologic studies, and controlled trials to advance our management of this problem.

Genital human papillomavirus infections in young women with vulvar and vestibular papillomatosis

Possible involvement of human papillomaviruses (HPV) in the development of vulvar and vestibular papillomatosis was investigated by using PCR to determine whether HPV DNA was present in lesions. Fourteen of 272 (5.1%) young women studied were found on gross and histological examination to have vulvar or vestibular papillomatosis. HPV DNA sequences were detected in cervicovaginal lavage specimens of 2 of 14 (14.3%) papillomatosis patients and 1 of 17 (5.9%) matched individuals in the control group without lesions. The difference in HPV prevalence between these two groups was not statistically significant (x2 = 0.51, p > 0.2). Furthermore, none of the 14 vulvar or vestibular papillomatosis biopsy tissues contained HPV DNA. The results suggest that vulvar and vestibular papillomatosis has an etiology other than HPV infection.