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.

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.

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