Syringoma are non-cancerous and harmless tumors of sweat ducts most often found in women during puberty and middle age. They are usually located in the lower eyelids and malar region; however, they can also be seen on other sites like the armpits, abdomen, upper chest, penis, and vulva. Syringoma of the vulva is thought to be rare because most of the cases are asymptomatic and may not be recognized over genitalia.
Vulvar syringoma may just appear on vulva alone or may be associated with eyelid syringoma or syringoma of other areas. There is no association of vulvar syringoma with systemic diseases.
Vulvar syringoma may starts in young age and in few cases other family members may also have been affected. Although most of the lesions are asymptomatic some may complain of vulvar discomfort, itching and burning sensation that is unresponsive to other conventional treatments affecting the quality of life. These lesions may be severe during menstruation, pregnancy and hot climates.
Vulvar syringomas are usually distributed symmetrically involving both labia majora. These lesions often present as multiple, small, firm, skin colored to yellow to light brown papules. Although most of the lesions are typical firm papules, some may present with cystic lesion or lichenoid plaque. Most of the lesions are asymptomatic, but they may occasionally itch or gets infected. Persistence of these harmless lesions can develop a fear in patients resulting in venereophobia and carcinophobia.
How is it diagnosed?
Clinically, vulvar syringoma may be often confused with many other genital dermatoses. So, it is important to visit a dermatologist to exclude other disease that affects genitalia. Common disease includes milia, Lichen Nitidus, lichen planus, molluscum contagiosum, seborrheic keratosis, senile angiomas, fox-fordyce disease, condyloma acuminata, steatocystoma multiplex, lymphangioma circumscriptum, lichen simplex chronicus, planar xanthomas and contact dermatitis, which can easily be differentiated on histopathology.
Vulvar syringoma that are itchy may cause lichenification of the area due to chronic scratching that might sometime alter the doctor diagnosis as lichen simples chronicus. So, when oral anti-histamines and topical steroids fail, one should suspect vulvar syringoma.
Treatment of Vulvar Syringoma
As vulvar syringoma are totally harmless, treatment is usually not necessary unless there is discomfort or is of cosmetic concern. For symptomatic lesions oral antihistamines and mild potent topical steroids may be applied that can relief itching but not the syringomas. For syringoma removal, destructive methods must be used either with excision, carbon dioxide laser, electro-desiccation or cryotherapy. Results may vary with different individuals and different doctors. Several researches suggest carbon dioxide to be effective in treating the lesions than any other modalities.References:
2. Agrawal S, Kulshrestha R, Rijal A, Sidhu S. Localized vulvar syringoma causing vulvar pruritus and venerophobia. Australas J Dermatol. 2004;45: 236-7.
3. Kopera D, Soyer HP, Cerroni L. Vulvar syringoma causing pruritus and carcinophobia: treatment by argon laser. J Cutan Laser Ther. 1999;1: 181-3.