10.5826/dpc.1401a15
text/xml
2160-9381
3375
en
Julia Maria Sánchez-Schmidt
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
female genitalia
Painful hemorrhage of vestibular papillae: a probably underreported complication of vestibular papillomatosis.
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2024-01-31
2023-03-27
2024-01-31
2024-02-21
e2024015
Dermatol Pract Concept
Julia Maria Sánchez-Schmidt
2024/01/31
10.5826/dpc.1401a15
e2024015
Hospital del Mar, Barcelona
2160-9381
female genitalia
en
e2024015
- Thakare SA, Udare S. Importance of Dermoscopy to Diagnose Vulvar Vestibular Papillomatosis vs. Warts. Indian Dermatol Online J. 2020 Jan 24;11(4):680-681.
Painful hemorrhage of vestibular papillae: a probably underreported complication of vestibular papillomatosis.
https://dpcj.org/index.php/dpc/article/download/3375/2544
             Painful Hemorrhage of Vestibular Papillae:
              A Probably Underreported Complication
                    of Vestibular Papillomatosis
                  Emilio Lopez-Trujillo1, Sonia Segura2, Julia Maria Sánchez-Schmidt1


1 Department of Dermatology, Hospital de Terrassa, Barcelona, Spain
2 Department of Dermatology, Hospital del Mar, Barcelona, Spain



Key words: vestibular papillomatosis, dermoscopy, vestibular papillae hemorrhage, female genitalia
Citation: Lopez-Trujillo E, Segura S, Sánchez-Schmidt JM. Painful Hemorrhage of Vestibular Papillae: A Probably Underreported
Complication of Vestibular Papillomatosis. Dermatol Pract Concept. 2024;14(1):e2024015. DOI: https://doi.org/10.5826/dpc.1401a15
Accepted: May 20, 2023; Published: January 2024
Copyright: ©2024 Lopez-Trujillo et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing Interests: None.
Authorship: All authors have contributed significantly to this publication.
Corresponding Author: Emilio Lopez-Trujillo, M.D, Department of Dermatology. Hospital de Terrassa, Barcelona. Carr. Torrebonica, s/n,
08227 Terrassa, Barcelona. Telephone: (+34) 619625427 / E-mail: emilio08tr@gmail.com




Introduction                                                             negative cervical cytology. She reported no genital trauma
                                                                         and sexual abstinence for the previous 3 months. Physical ex-
Vestibular papillomatosis (VP) is a benign condition of the              amination revealed a 3-mm painful e­ rythematous-violaceous
female external genitalia characterized by small projections             papule located at the edge of the left labia minora, accom-
or bumps on the vestibular area of the vulva, which can be               panied by multiple uniformly arranged, soft, skin-colored
mistaken for genital warts [1]. Some associated symptoms,                tubular papillae on inner labia, with round tips and separate
such as vestibular pruritus or dyspareunia, have been de-                bases, consistent with a diagnosis of vestibular papillomato-
scribed as possible complications [2]. Here we report the                sis (­Figure 1A). Dermoscopy revealed a well-circumscribed
first known case of painful hemorrhage of vestibular papillae            red-bluish papule with focal delicate scaling in the outer area
as a complication of VP.                                                 and multiple tortuous and linear vessels (Figure 1B). After
                                                                         further history taking the patient recalled tight-fitting clothes

Case Presentation                                                        as the only causative factor. As a differential diagnosis, papil-
                                                                         lary hidradenoma of the labia minora, vestibular gland cyst,
A 29-year-old female presented with a 2-day evolution of a               syringomas, condyloma acuminatum, vulvar endometriosis
rapidly growing, painful reddish lesion on the external la-              and other tumors that could present with hemorrhage were
bia minora. The patient was anxious about a possible ma-                 considered [3].
lignancy. She had no relevant medical history and did not                     The patient declined a biopsy of the papular lesion and
report previous vulvar pruritus or dyspareunia. The patient              a conservative approach with close monitoring was de-
had a normal gynecological check-up two weeks before, with               cided. We advised minimizing external irritants to the gen-
negative serology for sexually transmitted infections and                ital mucosa (eg avoiding tight clothing, harsh cleaning or



Research Letter | Dermatol Pract Concept. 2024;14(1):e2024015                                                                            1
                        Figure 1. Clinical and dermoscopic findings of vestibular papillomatosis complicated with
                        hemorrhage. (A) Painful erythematous vestibular papule with a violaceous hue at the ini-
                        tial visit. (B) Dermoscopy shows a red-bluish finger-like papule, in the context of vestib-
                        ular papillomatosis, with focal superficial scaling in the outer area and multiple tortuous
                        and linear vessels throughout its surface. (C) Complete self-resolution of papillae hemor-
                        rhage, resulting in reduction of its size and normalization of color at two weeks follow-up.
                        (D) Dermoscopy shows multiple pink, soft, uniformly arranged tubular papillae on inner
                        labia, with round tips and separate bases, and confirms hemorrhage resolution.




scratching). At the two-week follow-up, the papule had de-              findings complement the initial description of dermoscopy
creased in size (Figure 1C), was painless upon palpation and            features of VP by Thakare et al and underscore the utility of
showed normal color and appearance, similar to the contig-              dermoscopy in the diagnosis of VP lesions and their compli-
uous vestibular papules (Figure 1, C and D). Consequently,              cations [5].
the diagnosis of self-resolving hemorrhage of a vestibular                  This case serves to expand the knowledge base of VP and
papilla was established.                                                highlights the importance of considering a complicated ves-
                                                                        tibular papillomatosis in the differential diagnosis of genital
                                                                        lesions. Further studies are needed to better understand the
Conclusions                                                             impact of VP complications on the quality of life of the af-
Knowledge of the characteristic appearance and behavior of              fected patients.
VP is essential in distinguishing it from other genital lesions [4].
Clinicians must be sensitive to the emotional and psycholog-
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Research Letter | Dermatol Pract Concept. 2024;14(1):e2024015                                                                       3
