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Description
Sebaceous adenitis is an inflammatory dermatosis most commonly reported in animals. There have been rare reports in humans, mostly on the face and chest, with possible aetiological factors proposed including photodermatosis and Demodex mite. A hormone-response form of sebaceous adenitis occuring on the vulvar labia minora, clinically resembling hidradenitis suppurativa, has been postulated to be an unrelated and distinct condition.1 2
A 37-year-old woman presented with a 10-year history of intermittent, sometimes painful, labial cysts. These could resolve spontaneously or rupture. There was no obvious relationship to her menstrual cycle, but sometimes cysts became apparent after sexual intercourse. No treatment had been tried.
On examination, there were three firm smooth cysts on the inner mucosal aspect of the left labium minorum (figure 1). No surface change was visible.
Clinical: two smooth bluish cysts on the inner aspect of the left labium minorum.
One cyst was excised. The specimen of hairless skin showed a superficial dermal abscess centred on a sebaceous gland (figure 2). A sebaceous lobule in the wall of the abscess contained a pustule. Epithelial membrane antigen was positive in sebaceous epithelium on immunoperoxidase stain. No Gram-positive bacteria were seen in a Gram stain, and no yeast or fungi were seen on a periodic acid-schiff (PAS). A pathological diagnosis of sebaceous adenitis was made.
Histology: heavy perisebaceous and periadnexal inflammation. Arrow indicates inflammation directed against sebaceous glands.
An antiandrogenic contraceptive pill/oral contraceptives (cyproterone acetate 2000 µg, ethinylestradiol 35 µg) was prescribed, and in the subsequent 6 months of treatment, no further cysts had developed.
Vulvar sebaceous adenitis has been reported as a chronic relapsing condition, often over many years, in premenopausal adult women, typically with luteal phase exacerbation and resolution with the onset of menstrual flow. It is characterised by recurrent tender papules or nodules localised in the mucosal inner aspect of the labia minor. The nodules may discharge pus, swabs of which are typically negative for pathogens. In many cases, topical and oral corticosteroids, antiherpetics, antibiotics and anticandidal medications have been trialled unsuccessfully. However, in all reported cases, there has been an excellent response to oral tetracyclines (usually minocycline) or antiandrogen therapy such as spironolactone or cyproterone acetate.1 2
Patient’s perspective
I have been living with this uncomfortable condition for as long as I can remember. Finally seeing the right doctor and getting a real diagnosis that was so easily fixed feels like a miracle. The results were clear within a week and within a month, completely disappeared.
Learning points
Sebaceous adenitis of the vulva has been rarely reported and is probably distinct from the facial/truncal form.
Sebaceous adenitis of the vulva responds well to antiandrogens or tetracyclines, so it is an important diagnosis to consider.
Footnotes
Contributors DD-S was the dermatologist who cared for the patient. JS was the pathologist who made the diagnosis on biopsy.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.