/ /

  • linkedin
  • Increase Font
  • Sharebar

    Vulvar lesions in a 72-year-old woman


    Condylomata acuminata on the vulva (Figure 4) are caused by certain strains of the human papilloma virus (HPV), mostly HPV-6 and -11. HPV genital infections are the most common sexually transmitted disease (STD) in the United States. The appearance of condylomata is typically more exophytic than epithelial inclusion cysts with papillary projections and a sometimes “warty” appearance, and they can be firm or cornified. The warts vary in size from quite small, skin tag-like lesions to large lesions. At times, pigmentation changes are noted. 

    Excision or topical administration of trichloroacetic acid (TCA) or topical imiquimod or podophyllin can be used to treat HPV and they are ideal treatments for small areas.  When the disease is extensive, as in this patient, carbon dioxide laser is often used.

    Figure 5 shows papillomatosis in a 20 year-old which is a normal finding on the vulva. At times, it is confused HPV infection, but with papillomatosis, each projection comes off of a single pedicle. In HPV infection, in contrast, multiple projections come off a broad, single base.

    HSIL also are caused by HPV 

    HPV vaccination decreases the risk of developing HSIL of the vulva (Figure 6). Because cigarette smoking is a strong risk factor for HSIL, smoking cessation should be strongly encouraged.  Biopsy should be performed on suspicious lesions. Treatment is recommended because HSIL is considered a premalignant condition and wide local excision is performed in cases of suspected cancer. If occult invasion is not a concern, HSIL can be excised (hair-bearing areas), laser ablated (non-hair-bearing areas) or treated with topical imiquimod (off label use).


    Harle A, Kutz AM, Hadj-Rabia S, Mashiah J.  To treat molluscum contagiosum or not-curettage: An effective, well-accepted treatment modality. Ped Derm, 2016.

    Yang LJ, Zhu DN, Dang YL, Zhao X.  Treatment of condyloma acuminata in pregnant women with cryotherapy combined with proanthocyanidins: Outcome and safety.  ExpTher Med 2016;11:2391-2394.

    Hutchinson DJ, Klein KC. Human papillomavirus disease and vaccines. Am J HealthSyst Pharm. 2008;65(22):2105-2122.

    Centers for Disease Control and Prevnetion. Human papillomavirus (HPV). Available at http://www.cdc.gov/std/hpv/default.htm Accessed July 23, 2017.

    Goje O, Reutter J, Lawson H, Stockdale C. Obstet Gynecol. 2016 Oct;128(4):e178-82. 

    Diana Curran, MD
    Dr Diana Curran, MD is associate Professor, Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan, Ann Arbor.
    John O.L. DeLancey, MD
    DR. DELANCEY is Professor of Gynecology, director of Pelvic Floor Research, University of Michigan Medical School, Ann Arbor, MI.
    Hope K Haefner, MD
    Dr Hope K Haefner, MD, is Profesor in the Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan, Ann Arbor.


    You must be signed in to leave a comment. Registering is fast and free!

    All comments must follow the ModernMedicine Network community rules and terms of use, and will be moderated. ModernMedicine reserves the right to use the comments we receive, in whole or in part,in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

    • No comments available


    Latest Tweets Follow