Womens Health

Vulvar Sweat Gland Cysts

Frederick R. Jelovsek MD

Vulvar Cyst Questions

"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.



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