Vulval acne: A case series describing clinical features and management.

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Intermittent inflammation of the vulval pilosebaceous units is common and usually self-limiting, but some patients experience recurrent and more troublesome symptoms. There is a scarcity of information on this problem.We describe the clinical and histological features in these patients and the response to treatment.A retrospective, observational study of 16 patients with this phenomenon of recurrent, protracted folliculocentric inflammation of the vulval pilosebaceous unit was performed. Details on the clinical features, histology and response to treatment was collected.The mean age at presentation was 32 years (range 21-45 years). All patients reported recurrent painful papules and pustules on the labia majora and labia minora. Nine patients reported a cyclical pattern to the development of lesions with pre-menstrual exacerbation being the most common. Histology from these lesions showed folliculocentric microabscess formation surrounded by an acute and chronic inflammatory cell infiltrate, with a focal foreign body granulomatous reaction. All our patients responded well to tetracyclines, anti-androgenic or retinoid therapy CONCLUSIONS: We propose the term 'vulval acne' for this condition and hope to highlight this it as a common but underreported entity and propose a stepwise approach to its management.

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