Filiform Papules on the Labia Minora
A 23-year-old woman was referred for treatment of multiple papular lesions on the vulvae that the patient had noticed 1 year earlier. The lesions had not changed in number or size and were asymptomatic. She had received several treatments for condyloma accuminatum, such as imiquimod and podophyllotoxin without any improvement. No history of sexually transmitted infections was reported. The physical examination revealed multiple tiny, smooth, skin-colored papules (arrows), symmetrically distributed on the inner sides of her labia minora and the introitus (Fig. 1).
Hirsutoid papillomas of the vulvae, also known as vestibular papillomatosis, is a benign, asymptomatic anatomical variant of the vulvar epithelium present in approximately 1% of women.1 It is considered to be the female counterpart of the pearly penile papules of men.2 It is characterized by linear, pink, smooth, or filiform papules symmetrically distributed on the inner surface of both labia minora. Genital warts (condylomata acuminata) do not show this peculiar distribution, and their filiform projections tend to fuse at the base.3,4 Hirsutoid papillomas of the vulvae are more frequently found in women after puberty. It is important to recognize this anatomical variant to avoid unnecessary treatments.
1. Altmeyer P, Chilf GN, Holzmann H. Hirsuties papillaris vulvae (pseudocondylomata of the vulva). Hautarzt 1982; 33: 281–283.
2. Chan CC, Chiu HC. Images in clinical medicine. Vestibular papillomatosis. N Engl J Med 2008; 358: 1495.
3. Sarifakioglu E, Erdal E, Gunduz C. Vestibular papillomatosis: Case report and literature review. Acta Derm Venereol 2006; 86: 177–178.
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4. Wollina U, Verma S. Vulvar vestibular papillomatosis. Indian J Dermatol Venereol Leprol 2010; 76: 270–272.