Introduction

Intermittent inflammation of the vulval pilosebaceous units is common and usually self‐limiting, but some patients experience recurrent and more troublesome symptoms.

A 32-year old woman was admitted with a history of itching and pain of the vulvar region. Her clinical symptoms had expressivelyworsened, during a period of 6 months, resulting in painful urination and dyspareunia. Clinical examination revealed, smooth, whitish shiny plaques that affected the introitus vaginae, and the clitoral hood. Lesions extended to the posterior fourchette, perineum, and anus. The clinical picture recommended a diagnosis of Vulvar Acne.

Case Report

The external female genitals are called the vulva. Symptoms of vulvar conditions commonly include a burning sensation, stinging or itching. In some cases, the vulva appears red and swollen.

To rule out differential diagnoses including lichen planus, cicatricial pemphigoid, morphea, and intraepithelial neoplasia, a skin biopsy specimen was obtained. Histopathologic examination displayed pronounced hydropic degeneration of the basal cell layer, edema, homogenization of collagen in the upper dermis, and a prominent bandlike inflammatory infiltrate in the lower dermis. These findings confirmed the diagnosis of Vulvar Acne. Gram stains of cervical, vaginal, and urethral swabs revealed regular epithelial cells and lactobacilli without signs of inflammation. Human papillomavirus (HPV) DNA was not detected by hybridization tests of vulvar and perianal swabs. Autoantibodies to a variety of targets (nuclear, microsomal, and thyroid) were not detected.

Discussion

Numerous treatment options for lichen sclerosus have been proposed, but therapeutic results are often of limited efficacy and provide only temporal relief. Potent corticosteroids applied topically are generally considered the first-line treatment. None of the therapeutic regimens used in our patient, however, were sufficiently beneficial. The patient continued to refrain from sexual intercourse owing to severe vulvar discomfort. Urination and defecation remained painful and frequently required analgesic medication. The challenge was to find a safe and effective alternative therapy to induce long-term improvement or complete remission of the disease.

Therapy was initiated with topical retinoid applied twice daily to affected areas. During follow-up visits after 2, 4, 6, 9, and 12 weeks, the patient reported progressive improvement of the clinical symptoms. Pain and burning sensations had disappeared after 6 weeks, and the patient was able to resume sexual intercourse by 12 weeks of 0.1% topical retinoid application. Complete resolution of visible lesions was observed another 4 weeks later, and therapy with topical retinoid was stopped after 6 months of continuous application twice daily. Except for mild temporary burning sensations shortly after application of the ointment, no adverse effects were reported.

Conclusion

Vulvar Acneis a chronic inflammatory disease of unknown cause. Typically, the eruption begins as an area of pallor, with white, waxy, polygonal papules that coalesce into shiny plaques. The skin is thinned and atrophic and shows disruption of its regular architecture. Vulvar Acnemay result in significant psychosocial distress and anxiety severely affecting quality of life.

A likely but unproven cause of Vulvar Acneinvolves an autoimmune mechanism. Although various autoantibodies directed against thyroid, microsomal, nuclear, and mitochondrial antigens have been reported to be more common in patients with Vulvar Acnethan in healthy controls.

Application of topical retinoid ointment is considered the treatment of choice.

Thus, since the patient applied 0.1% topical retinoid ointment to an area, the risk for systemic adverse effects is exceedingly low. When Vulvar Acneis treated with topical retinoid, most patients require long-term regular application.

In conclusion, the introduction of topical retinoid for the treatment of Vulvar Acnehas shown significant efficacy and an excellent safety profile with few notable local adverse effects and a minimal risk of systemic adverse effects.

Suggested Reading

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