"For the last 6 months I have been having
problems with sweat gland cysts on my vaginal area.
I have had 2 removed and now have a third on that
needs removing, what caused these and is there anything
that can be done to prevent them? My doctor says no!
Thank you ".
anonymous
There are several skin structures on the vulva that
can become infected or grow into nodules and bumps
that can be quite irritating. As with any skin, there
are hair follicles, sweat glands and other skin glands
such as Bartholin glands, and vestibule glands. Infectious
agents such as viruses and bacteria can cause skin
lumps as well.
When a doctor examines the vulvar area, some of the
lesions may have characteristic appearances such as
HPV virus causing condyloma accuminata, a pox virus
causing Molluscum contagiosum, or Herpes Simplex virus
causing genital herpes. These can be diagnosed just
by looking at the lesions. Other lesions however are
not so obvious to diagnose and they may need to have
biopsies or special tests performed in order to confirm
what is causing the lump or lesion. Since biopsies
are painful and some of the tests are expensive, doctor
may choose to avoid a biopsy if the lesion in unlikely
to be malignant and it appears to be a one or two
time problem - not a chronic recurrence. When this
happens, the doctor just gives you "a best guess".
It is not uncommon to label a vulvar lump or pustule
as a hair follicle inflammation or a sweat gland cyst
when in fact the degree of certainty is not very high.
If the lesion goes away on its own or with simple
treatment of sitz bath cleansing or antibiotics, then
preciseness of diagnosis is less crucial. The truth
is, however, that these lesions need to be biopsied
to be sure of what they are. There are many different
entities or conditions that can present this way on
the vulva and if the problem is recurrent, biopsies
are necessary.
What are the different diseases that cause multiple
cysts of the vulva?
While the list of vulvar conditions that can produce
cystic lesions or nodules of the vulvar is numerous,
there are several conditions that are more commonly
seen.
Non pus draining lesions
Epithelial inclusion cyst (keratinous cyst) - blocked
sweat gland or follicle cysts - requires biopsy
skin tumors - mucous cysts, hidradenoma, acrochordon
(fibrous polyp) - requires biopsy
condyloma lata (lesion of syphilis) - blood test,
biopsy
Infected, pus draining lesions
Folliculitis (bacterial inflammation) of a hair follicle
- self limited
Fox-Fordyce disease - inflammatory (non STD) condition
of skin sweat glands - requires biopsy
Hidradenitis suppurativa - inflammatory (non STD)
disorder of skin sweat glands - requires biopsy
Granuloma inguinale - bacterial STD requiring biopsy
Lymphogranuloma venereum - bacterial STD requiring
immunological blood test of culture
Chancroid - bacterial STD requiring culture
The above is only a limited selection of possibilities.
As you can see, biopsies or tests are needed to be
sure. If your doctor has not done a biopsy, perhaps
you should ask if one would be helpful. Epithelial
inclusion cysts, probably the most common of these
problems, has a different treatment than hidradenitis
suppurativa or Fox-Fordyce disease and a different
clinical course.
If epithelial inclusion cysts are the most common
vulvar sweat gland problem, how are they treated?
Epithelial inclusion cysts result when a duct is plugged
up and the skin cells, squamous cells, that are usually
sloughed as they naturally die off, cannot get out
of the duct. New cells keep forming, however and a
cyst filled with cells forms under the skin. If those
cysts are opened surgically, a cheesy -like contents
are extruded.
Some women may form these as a result of surgery
or an episiotomy during delivery. Others just seem
to have a tendency for the vulvar skin ducts to get
plugged up. The only treatment for these is to surgically
open the cysts with a needle or scalpel wide enough
not to get replugged up, or to actually surgically
excise the cyst and close the skin with a stitch.
Remember that epidermoid cysts are usually not infected
with bacteria unless you have been squeezing them
and the cyst breaks up into the skin rather than to
the surface of the skin.
If the vulvar sweat glands become swollen, inflamed
and sometimes drain like severe acne, what can be
done?
The first step is to be absolutely sure of the diagnosis.
If there are draining, reddened cysts like a pustular
acne, a biopsy usually has to be performed in order
to confirm what type of lesion in present. Fox-Fordyce
disease and hidradenitis suppurativa are very similar.
They can both affect the arm pits (axilla) as well
as the vulva. Fox-Fordyce disease is a chronic blockage
of the sweat gland ducts with a secondary, non bacterial
inflammatory response to the secretions and cellular
debris in the cysts. Hidradenitis is very similar
but tends to have a secondary bacterial infection
so that pus draining sinuses are formed. It is a very
devastating skin disease that does not have universally
curative treatments. Often surgery with complete excision
of the gland bearing skin under the arms or across
the entire vulva may need to be performed. Irradiation
therapy may also be used and antibiotics are used
to reduce the inflammatory response.
Since hidradenitis suppurativa is such a chronic
devastating disease, large support groups have been
formed and help disseminate the latest information
about the disease. Some women respond with treatment
to antibiotics, Accutane®, or hormonal treatment
(e.g., Lupron®) but the mainstay treatment is
surgical removal of the skin tissue containing affected
sweat glands. |
