Importance of Dermoscopy to Diagnose Vulvar Vestibular Papillomatosis vs. Warts

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680 © 2020 Indian Dermatology Online Journal | Published by Wolters Kluwer - Medknow
A 29 year old healthy, married, nulliparous
female, was referred by a gynecologist for
genital warts. She presented with a history
of asymptomatic, multiple painless growths
in vulva/vagina with nger‑like projections.
The lesion was noticed after marriage and
was very gradually increasing in size. She
did not suer from any discomfort, or
bleeding during sexual intercourse.
She had a monogamous relationship with
her husband and gave no history of any
extramarital or premarital sexual contacts.
On examination, vulva appeared normal
except for the lesions she was complaining
about. There were no vulval or vaginal
ulcers. Examination of the vestibule and
inner aspect of right labia minora revealed
skin colored translucent, papules some of
which appeared digitate. They were soft
to feel, non‑tender, and did not bleed on
touch. Few lesions looked quite similar
to elongated pearly penile papules (PPP),
which appear in males [Figure 1].
Dermoscopy under polarized light
with DermLite DL200 Hybrid
dermoscope (3Gen) conrmed the presence
of profuse and irregular vascular channels
in multiple cylindrical liform projections.
The bases of the individual projections
remain separate [Figure 2]. There was
no keratotic growth; nor colored dots
suggestive of thrombosed vessels, thus,
conrming that the lesion was not a wart.
The lesion was excised and sent for
histopathology, following features were
seen: well‑dened papillated lesion covered
by hyperplastic epidermis with mild
spongiosis in foci. An increased number
of thin‑walled dilated capillaries with a
sparse mixed inammatory inltrate of
lymphocytes, neutrophils, and plasma cells
were seen on the dermis. Koilocytes were
Address for correspondence:
Dr Sampada Avinash Thakare,
Department of Dermatology,
Venereology and Leprosy,
Govt. Medical College,
Ramnagar Road, Civil Lines,
Chandrapur, Maharashtra ‑
442 402, India.
E‑mail: drsampadathakare@
gmail.com
Access this article online
Website: www.idoj.in
DOI: 10.4103/idoj.IDOJ_463_18
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Importance of Dermoscopy to Diagnose Vulvar Vestibular Papillomatosis
vs. Warts
Throughthe Dermoscope
Sampada
Avinash Thakare,
Satish Udare1
Department of Dermatology,
Venereology and Leprosy, GMC,
Chandrapur, 1Sparkle Skin
Clinic, Vashi, Navi Mumbai,
Maharashtra, India
How to cite this article: Thakare SA, Udare S.
Importance of dermoscopy to diagnose vulvar
vestibular papillomatosis vs. warts. Indian Dermatol
Online J 2020;4:680-1.
Received: December, 2018. Accepted: June, 2019.
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not visible, and therefore, the diagnosis
of vulvar vestibular papillomatosis was
conrmed [Figure 3]. The patient was
reassured about the benign nature of
the disease, and stressed that no further
treatment was necessary.
Vulvar vestibular papillomatosis is a
benign condition that can be regarded
as the female equivalent of PPP in male
genitals.[1] Vestibular papillomatosis[2] is a
condition where a large number of papillae
cover the entire surface of labia minora in
a symmetric fashion. The dermoscopy of
Pearly penile papules (PPP) appears white
or pink in a cobblestone or grape‑like
pattern with each papule containing central
dotted or comma‑shaped vessels,[3] whereas
dermatoscopic features of genital warts
morphologic features may vary from a
ngerlike to knoblike pattern, and the
vascular pattern can be from glomerular
to dotted.[4] Unlike warts, however, PPP
Figure 1: Multiple pink colored, translucent, digitate
papules present on inner aspect of right labia minora
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Thakare and Udare: Vulvar vestibular papillomatosis
681Indian Dermatology Online Journal | Volume 11 | Issue 4 | July-August 2020
does not have desquamation, which is seen as an irregular
reection on dermoscopy.
Papillary projections of the inner labia have been
routinely diagnosed as caused by Human Papilloma
Virus infection (HPV). Careful identication of clinical
parameters of vestibular papillomatosis reveals that they
are clusters of pink, soft, uniformly arranged tubular
papillae on inner labia, hymen, or periurethral area with
round tips and separate bases. However, genital warts
are skin‑colored or pigmented, randomly arranged, rm,
acuminate papules, individual papillary projections fused
at the base.[5]
However, there has been a scarcity of literature about
this rare entity in Indian dermatological scenario; this is
only the fourth case reported after Wollina and Verma,[6]
Mehta et al.[7] and Kakkar[8] highlighting an apparent
disregard for this potentially misdiagnosed entity.
Declaration of patient consent
The authors certify that they have obtained all appropriate
patient consent forms. In the form the patient(s) has/have
given his/her/their consent for his/her/their images and
other clinical information to be reported in the journal. The
patients understand that their names and initials will not
be published and due eorts will be made to conceal their
identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conicts of interest
There are no conicts of interest.
References
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Dermatol 1973;108:673‑5.
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prevalence, aetiology and natural history. Br J Obstet Gynaecol
1993;100:939‑42.
3. Ozeki M, Saito R, Tanaka M. Dermoscopic features of pearly
penile papules.Dermatology2008;217:21‑2.
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Acad Dermatol2011;64:859‑64.
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Arch Dermatol 1990;126:1594‑8.
6. Wollina U, Verma S. Vulvar vestibular papillomatosis. Indian J
Dermatol Venereol Leprol 2010;76:270‑2.
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the vulva. Indian J Sex Transm Dis 2009;30:125‑6.
8. Kakkar S, Sharma PK. Benign vulvar vestibular papillomatosis:
An underreported condition in Indian dermatological literature.
Indian Dermatol Online J 2017;8:63‑5.
Figure 2: Dermoscopy under polarized light with DermLiteDL200 Hybrid
dermoscope (3Gen) conrmed the presence of profuse and irregular
vascular channels in the transparent core of the multiple, cylindrical liform
projections. The bases of the individual projections remain separate
Figure 3: Well-dened papillated lesion covered by hyperplastic epidermis
with mild spongiosis in foci. An increased number of thin-walled dilated
capillaries with a sparse mixed inammatory inltrate comprising of
lymphocytes, neutrophils, and plasma cells was seen on the dermis.
Koilocytes were absent (H and E with 10×)
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