Papillae, Skin Tags, and Scars
Vestibular papillae (also known as vestibular papillomatosis) are a common, normal finding in women [1].
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David Nunns and Rosalind Simpson
12.1 Papillomatosis of the Vestibule and Medial Labia Minora Vestibular papillae (also known as vestibular papillomatosis) are a common, normal finding in women [1]. They have no distinctive histopathological appearances and, in the past, were mistaken for HPV infection [2]. They are asymptomatic and present as small soft papillae, variable in number, and located in the vestibule and medial labia minora (Fig. 12.1). They can vary in size with some being up to 6 mm in length and 1–2 mm wide. They are skin colored and can occur in isolation or can cover the vestibule. No investigation is needed, and they can be diagnosed clinically. As they are a normal finding, no treatment is required, and patients can be reassured. Fig. 12.1 Vestibular papillae (vestibular papillomatosis)—soft papillae in the medial labia minora. Courtesy of Professor Jacob Bornstein D. Nunns (*) Department of Gynaecological Oncology, Nottingham University Hospital, Nottingham, UK R. Simpson Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK e-mail: [email protected]
12.2 Skin Tags (Acrochordon, Fibroepithelial Polyp) These are benign, very common skin tags often found on the neck, groin, and anogenital
© Springer International Publishing AG, part of Springer Nature 2019 J. Bornstein (ed.), Vulvar Disease, https://doi.org/10.1007/978-3-319-61621-6_12
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area. On the vulva, they can involve the labia majora. They are associated with obesity and diabetes. Histologically, the features are bland with normal epidermis covering connective tissue. Clinically, they are skin-colored, soft, painless tags that can range in size from a few millimeters to several centimeters. They are usually asymptomatic; therefore, patients should be reassured. Removal may be indicated if patients have concerns, or they are associated with dyspareunia. Methods of excision include excision under local anesthetic or cryotherapy.
12.3 Vulvar Scar Scar tissue is common on the vulva especially among women who have undergone vulvovaginal surgery such as episiotomy or prolapse repair. Histologically there is usually bland fibrous tissue, but scars are usually evident from a history and clinical examination. No treatment is necessary if the patient is symptom-free. Surgical excision of scar tissue has a limited place in management as this can cause more scar tissue and may not reduce symptoms or improve function. However, symptomatic vulvar scarring, such as that causing dyspareunia or pain when at the posterior
fourchette, may require adjusting using techniques such as Z-plasty [3].
Papillae, Skin Tags and Scars: Breaking the Myths
• Vestibular papillae (also known as vestibular papillomatosis) were mistaken for HPV infection and treated. However, they are a common, normal finding in women and need no treatment. • Skin tags are benign and common. However, they may be associated with obesity and diabetes. • Vulvar scarring rarely requires surgical excision as s
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