Vulvar syringoma causing pruritus and carcinophobia: treatment by argon laser

Syringomas are benign lesions most commonly appearing around the eyelids and in malar areas, but they have also been described on other body sites. Depending on the site they may cause either aesthetic disturbance (e.g. face, neck, arms) or pruritus (e.g. vulva). This is the first report of argon laser treatment of syringoma in a patient with multiple vulvar syringomas in association with pruritus vulvae and carcinophobia.     

女阴汗管瘤3例

报告3例局限于女阴的汗管瘤。患者均为青年女性,皮疹均表现为外阴部散在粟米至绿豆大的肤色或淡褐色扁平丘诊,表面光滑,患者无明显自学症状。1例患者的皮诊受月经周期影响。3例患者均经过组织病理检查确诊。     

女阴汗管瘤1例

报告１例２６岁女阴汗管瘤患者,双侧大阴唇可见绿豆大结节,丘疹,部分融合,会阴部针尖大丘疹,伴有瘙痒,皮损受月经周期影响,组织病理发迹示典型汗管瘤。     

Localized vulvar syringomas

Syringomas are benign appendageal tumors with differentiation toward the intraepidermal portion of the eccrine sweat duct. A 35-year-old black woman with lesions confined to the labia majora is presented. Syringomas involving the genitalia are rare, and usually the genital tumors are part of a more generalized distribution. A review of English literature showed only four reported cases of syringomas limited to the vulva. Vulvular syringomas present as multiple, bilateral, skin-colored papules over the labia majora that may or may not be pruritic. The lesions should therefore be considered in the differential diagnosis of multiple papular lesions of the vulva and are probably more common than is generally recognized.     

Patients with vulval pruritus: patch test results

Background:  Persistent vulval pruritus is a frequent problem and patients may not show signs of a primary vulval dermatosis. Allergic contact sensitivity is an important factor in such patients but may also occur as a secondary event in women with vulval dermatoses.
Objectives:  We aim to describe women with vulval pruritus who were evaluated for vulval dermatoses. We patch tested to help define or exclude allergens.
Methods:  In a 3-year period, 50 women with vulval pruritus were examined for existence of vulval dermatosis. All the patients were patch tested to the European Baseline Series, medicaments, preservatives, vehicles, cosmetics and products they routinely used.
Results:  Ages of the patients ranged from 22 to 62 years (mean 39.9 ± 9 years) and duration of the diseases ranged from 0.5–360 months (mean 56.1 ± 65.6 months). 52% of the women had at least 1 positive patch test. 8 patients (16%) had 1 or more relevant allergic positive reactions. The relevant allergens were usually cosmetics, preservatives and medicaments.
Conclusions:  Women with vulval pruritus were patch tested to help define or rule our allergens. Contact allergy incidence in these patients is high. The relevant allergens were usually cosmetics, preservatives and medicaments.     

Localized childhood vulval pemphigoid treated with tacrolimus ointment

BACKGROUND: Localized vulval childhood pemphigoid is a rare variant within the pemphigoid group. Although its prognosis seems favorable, the best therapeutic strategy remains unclear. OBSERVATION: We here describe the case of an 8-year-old girl presenting with a 5-year history of relapsing vulval pain and lesions suggestive of lichen sclerosus. Clinical features, light microscopy and direct immunofluorescence microscopy were consistent with vulval cicatricial pemphigoid, although the autoantigen(s) involved could not be characterized. Her disease responded to treatment with topical tacrolimus ointment 0.1% within 3 months without any evidence for disease activity, except for slight residual scarring. After 12 months, her treatment was stopped without relapse. CONCLUSION: This observation suggests that in this rare immune-mediated blistering disease topical tacrolimus is an interesting therapeutic option without the adverse effects associated with topical steroids.     

Prospective study of patch testing in patients with vulval pruritus

Forty-three patients with the primary complaint of vulval pruritus were recruited to take part in this prospective patch-testing study. A detailed questionnaire was administered to each and patch testing to an extended battery of allergens was undertaken. This included the European standard series, preservatives, corticosteroids and a battery of common over-the-counter topical vulval treatments. Analysis of demographic data and prior treatments used, and various other parameters, were studied in the context of patch-test results. This prospective study reports a very high rate of contact sensitivity in patients presenting with vulval pruritus, with 81.4% of those tested having at least one contact allergen detected. One or more clinically relevant allergens were found in 44% of the subjects patch tested. The variables found to predict a greater likelihood of a contact allergy were a biopsy diagnosis of vulval dermatitis, the use of multiple topical treatments, sexual inactivity and patients with severe pruritus on a self-reported scale. Most importantly, many clinically relevant allergens these patients reacted to were outside the European standard series. This highlights the need for an extended series in this patient population.     

Localized hyperpigmentation and pruritus on the upper back

This retrospective study of 28 patients with pruritus and hyperpigmentation located on the upper half of the back, without involvement of other skin areas, includes 8 cases of macular amyloidosis, four neurodermatitis and 16 compatible with what has been described as notalgia paresthetica (NP). With the exception of the amyloid deposition, we did not find histopathological data that differentiated between macular amyloidosis and NP, since in both processes we found necrotic keratinocytes and melanophages. The differential diagnosis and the current nosological situation of the hyperpigmentation localized on the upper back are reviewed. A diagnostic protocol is proposed.     

Localized blanching erythema in a patient with vulvar carcinoma

Mammary-like carcinoma arising in the vulva is a rare type of vulvar malignancy. Cutaneous metastasis of vulvar carcinoma is uncommon and the majority of cases have been reported in patients with squamous cell carcinoma of the vulva. We describe a 69-year-old woman with mammary-like carcinoma of the vulva with cutaneous metastasis presenting as asymptomatic localized blanching erythema.     

Localized vulvar bullous pemphigoid of childhood: A rare cause of persistent vulvar erosions in children

Localized vulvar bullous pemphigoid of childhood is an excessively rare variant of bullous pemphigoid and affects almost exclusively young girls of 7‐12 years of age. In contrast to adult‐onset bullous pemphigoid, a prompt response to potent topical corticosteroids is observed in the majority of cases, with a favorable prognosis and rare relapses. We report the case of a 7‐year‐old girl who presented with this condition. Our case reinforces the recognition of this rare subtype of childhood bullous pemphigoid as a distinct entity and enlightens the importance of performing a cutaneous biopsy when clinically indicated.     

Extensive pigmented vulvar basal-cell carcinoma presenting as pruritus in an elderly woman

Basal cell carcinoma (BCC), the most common human cancer, is seldom seen in the genital area. We present a case of an extensive pigmented BCC that developed on the mucosal surface of the vulva of an elderly woman and briefly review the relevant literature on vulvar BCC.     

Localized vulvar pemphigoid in a child misdiagnosed as sexual abuse.

BACKGROUND--Various primary dermatoses can affect the vulva of children and be misdiagnosed as child abuse, with devastating social consequences. OBSERVATION--A 3-year-old girl with vulvar erosions was removed from her parent's care after a pediatrician and gynecologist diagnosed child abuse. Histopathologic and immunofluorescence studies were consistent with vulvar pemphigoid. CONCLUSION--Localized pemphigoid should be added to the differential diagnosis of vulvar lesions. Dermatologists, pediatricians, and gynecologists should be familiar with nonvenereal diseases that can exclusively affect this area. The dermatologist's expertise is particularly valuable in differentiating between primary diseases and sexual abuse.     

Localized chronic fibrosing vasculitis causing a rhinophymatous eruption

We describe a patient with localized chronic fibrosing vasculitis who presented with a rhinophymalike eruption of the nose. To our knowledge, the manifestation of this condition on the nose has not been previously reported. The differential diagnosis also is examined.     

Clinical care of vulvar pruritus, with emphasis on one common cause, lichen simplex chronicus

Vulvar pruritus is a common and distressing condition for patients, and its presentation is often delayed and complicated by home remedies. The true prevalence cannot be accurately estimated. Vulvar pruritus is a symptom, and an underlying cause must be sought and not assumed. This is best accomplished by obtaining a careful history of vulvar care regimens and treatments, performing a detailed physical examination, and considering a broad differential diagnosis. This article provides a practical and clinical approach to the evaluation of vulvar pruritus and then focuses specifically on one common cause, lichen simplex chronicus.