Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Quiz
ARTICLE IN PRESS
doi:
10.25259/IJDVL_587_2023

Papular lesions on the vulva

Department of Dermatology and STD, VMMC and Safdarjung Hospital, Delhi, India
Corresponding author: Dr. Niharika Dhattarwal, Department of Dermatology and STD, OPD 5th floor VMMC and Safdarjung Hospital, Delhi, India. niharika.pgirtk@gmail.com
Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Dhattarwal N, Kapil K. Papular lesions on the vulva. Indian J Dermatol Venereol Leprol. doi: 10.25259/IJDVL_587_2023

A 40-year-old woman presented with skin-coloured, mildly itchy raised lesions on her vulva for 2–3 years. On examination, multiple, firm, freely mobile, non-tender papules of approximately 1 cm size were present on the bilateral labia majora [Figure 1]. One of the papules was excised and sent for histopathological examination [Figures 2a and 2b].

Figure 1:
Skin-coloured papules present on the vulva.
Figure 2a:
Histopathology showing multiple variable-sized eccrine tubules with secretions and lined with a double layer of epithelium along with a few immature pilar structures (Haematoxylin & Eosin; 100x).
Figure 2b:
Some of the eccrine ducts have elongated tails of epithelial cells giving them a comma-shaped or tadpole appearance (Haematoxylin & Eosin; 400x).

Question

What is your diagnosis?

Diagnosis

Vulvar syringomas

Discussion

Syringomas are benign appendageal tumours derived from the intraepidermal part of eccrine glands. The estimated prevalence is 1% worldwide.1 Exact aetiopathogenesis remains elusive. Hormonal influence is suggested as they are commonly seen in women, increase in size during pregnancy, in the premenstrual period, and with oral contraceptives.2 Some authors also suggest a possible effect of race as higher incidence is seen in Asians and African Americans.3 The role of inflammation and association with other autoimmune diseases like alopecia areata and vitiligo also need careful interpretation.1 The most common age group is adolescence and peripubertal but may also occur in children and elderly postmenopausal women.

Syringomas are classified into four types:

  • 1.

    Local type: Most common, seen in the periorbital area.

  • 2.

    Generalised (multiple and eruptive) types: Affecting two or more anatomical sites, seen on the neck, anterior chest, abdomen, and/or axilla, and associated with hereditary or systemic diseases such as hyperthyroidism, diabetes, Marfan’s syndrome, and Ehlers–Danlos syndrome.1

  • 3.

    Down syndrome-associated type.

  • 4.

    Familial type: Autosomal dominant, seen in unusual sites like the palms and neck.

Vulvar involvement is uncommon and can be seen in localised and eruptive types.4 In a study of 90 cases of eruptive syringomas, only one patient had vulvar involvement.1 Isolated vulvar syringomas without any extragenital involvement are even rarer. Clinically, there are three types of presentations:

  • 1.

    Papular type (most common): Multiple skin-coloured, brown, or slightly yellow papules in a symmetrical distribution are present. Usually asymptomatic and patients often delay seeking treatment.

  • 2.

    Cystic type: Milia-like whitish cysts are seen.

  • 3.

    Lichenified type: The pruritus is very severe leading to lichenification and even pseudohypertrophy of the vulva.4

In a report of two cases of localised vulvar syringomas by Pai et al., both patients had papular-type lesions.2

Diagnosis is obtained by clinicopathological correlation. In histopathology, ductal structures lined by a double layer of flattened cuboidal epithelium with small nuclei are seen along with amorphous material in the lumen, suggestive of eccrine differentiation. A characteristic diagnostic feature is the presence of tail-like elongation from one end of the duct into the stroma known as a ‘tadpole’ or ‘comma’ appearance. Dermoscopy may also provide a clue to the diagnosis. Some authors have reported the presence of distinct variable-sized, glittering yellow-whitish structures over a fading pink background. Others have also noticed ill-defined, brown incomplete pigment networks and delicate vascular networks.5

Other differentials for papular lesions on the vulva include Fox-Fordyce disease, epidermal cysts, milia, senile angiomas, condyloma acuminata, and steatocystoma multiplex.

Medical treatment options administered with success include topical atropine, topical adelmidrol, topical steroids, tretinoin, oral tranilast, and intradermal botulinum toxin. Destructive modalities like CO2 lasers, electrocautery, cryotherapy, and surgical excision can also be performed.1

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Use of artificial intelligence (AI)-assisted technology for manuscript preparation

The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.

References

  1. , , , , , . Eruptive syringomas: Summary of ninety cases and a brief literature review. J Cosmet Dermatol. 2023;22:1128-33.
    [CrossRef] [PubMed] [Google Scholar]
  2. , , , , . Vulvar syringoma – A rare distribution of a common entity: Report of two cases. J Dermatol Dermatol Surg. 2020;24:140-2.
    [Google Scholar]
  3. , , , , . Late-onset of eruptive syringomas: A diagnostic challenge. An Bras Dermatol. 2015;90:239-41.
    [CrossRef] [PubMed] [Google Scholar]
  4. , , , , , . Vulvar syringomas as a part of nonfamilial generalized eruptive form: Unusual lesions leading to pseudohyper-trophy of the labia majora. Dermatol Online J 2018:2413030/qt1rx2v8hc.
    [Google Scholar]
  5. , , , . Eruptive syringoma: Two cases with dermoscopic features. Skin Appendage Disord 2020:6319-22.
    [Google Scholar]

Fulltext Views
1,614

PDF downloads
788
View/Download PDF
Download Citations
BibTeX
RIS
Show Sections