Fiona M. Lewis Cutaneous appendageal structures include sebaceous and sweat glands and hair follicles, which have functions of lubrication and temperature regulation. These are all found on the vulva, and disorders affecting these structures will therefore be seen regularly in clinical practice. Sebaceous glands are numerous on the vulva and are usually easily seen on the labia majora and minora (see Chapter 2). They do diminish with age and are also disrupted in lichen sclerosus and lichen planus. On the labia minora, they end where Hart’s line marks the boundary of the vestibule. Secretion from the glands may accumulate between the labia, and patients who complain of soreness or a subjective sensation of swelling in this area often have unusually profuse glands. Sebaceous hyperplasia is uncommon on the vulva but is reported where soft polypoid lesions occur, and histology shows hyperplasia of the sebaceous glands [1]. Vulval acne is a recently described entity where patients develop recurrent and troublesome inflammatory lesions of the vulval pilosebaceous unit [2]. It is more common in younger women. It is likely that the pathophysiology is similar to that of acne vulgaris in that there is an abnormal cutaneous response to hormones with resulting inflammation. Histology shows folliculocentric microabscess formation with a surrounding acute and chronic inflammatory cell infiltrate. There may be a foreign body granulomatous reaction in some cases. Recurrent inflammatory papules and pustules occur on the labia minora and inner aspects of the labia majora (Figure 30.1). They do not scar. There is often a pre‐menstrual flare of symptoms, and there may be a history of facial acne in some patients. The differential diagnosis includes bacterial folliculitis, hidradenitis suppurativa, and sebaceous adenitis. Figure 30.1 Vulval acne. Inflammation and pustule in right interlabial sulcus. Mild disease may respond to topical antibiotics, but a step‐wise approach including oral antibiotics, anti‐androgen therapy, and low‐dose isotretinoin is suggested [2]. Sebaceous adenitis has been described in animals where inflammation of the sebaceous gland can eventually cause it to be destroyed. A series of 11 patients with tender nodular lesions on the labia minora has been described [3]. These were termed sebaceous adenitis, and they responded to tetracyclines and antiandrogens. It is likely that these cases and vulval acne are a spectrum of the same condition. One case of vulval pustules occurring in a patient with severe facial rosacea fulminans is reported [4]. Milia are small cysts arising from the pilosebaceous unit.
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Disorders of Skin Appendages and Hair
Disorders of sebaceous glands
Vulval acne
Epidemiology
Pathophysiology
Histological features
Clinical features
Differential diagnosis
Treatment
Sebaceous adenitis
Rosacea
Milia
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