Pseudofolliculitis or Mechanical Folliculitis This is similar to what is described as pseudofolliculitis barbae (razor bumps) and may occur in women who follow the popular practice of shaving pubic hair (234). Pseudofolliculitis consists of an inﬂammatory reaction surrounding an ingrown hair and occurs most commonly among individuals with curly hair, particularly African Americans.
Infectious Folliculitis Shaving may be associated with an infectious folliculitis, commonly caused by Staphylococcus aureus and Streptococcus pyogenes. Shaving and other methods of pubic hair removal are associated with razor burn, contact dermatitis, and the transmission of other infectious agents such as Molluscum contagiosum, HPV, and herpes simplex along with other bacteria including Pseudomonas aeruginosa (234).
Fox-Fordyce Disease This condition is characterized by a chronic, pruritic eruption of small papules or cysts formed by keratin-plugged apocrine glands. It is commonly present over the lower abdomen, mons pubis, labia majora, and inner portions of the thighs. Hidradenitis suppurativa is a chronic condition involving the apocrine glands with the formation of multiple deep nodules, scars, pits, and sinuses that occur in the axilla, vulva, and perineum. Hyper-pigmentation and secondary infection are often seen. Hidradenitis suppurativa can be extremely painful and debilitating. In the past, it was treated with antibiotics, isotretinoin, or steroids; surgical therapy with wide local excision may be necessary. Tumor necrosis factor-α inhibitors show promise in treatment (235).
Acanthosis Nigricans This disease involves widespread velvety pigmentation in skin folds, particularly the axillae, neck, thighs, submammary area, and vulva and surrounding skin (Fig. 14.32). It is of particular interest to gynecologists because of its association with hyperandrogenism and PCOS; as such, it is associated with obesity, chronic anovulation, acne, glucose
Figure 14.32 Acathosis nigricans of the neck.
Vulvar Tumors, Cysts, and Masses intolerance, insulin resistance, and cardiovascular disease (159,236). Topical and oral retinoids are used to treat the acanthosis nigricans, along with management of the underlying conditions including obesity and insulin resistance or diabetes (237).
Extramammary Paget’s Disease This is an intraepithelial neoplasia containing vacuolated Paget’s cells (see Chapter 19). Clinically, the appearance of Paget’s disease is variable, and it may have an appearance varying from moist, oozing ulcerations to an eczematoid lesion with scaling and crusting to a grayish lesion (238). It may be confused with candidiasis, psoriasis, seborrheic dermatitis, contact dermatitis, and VIN. A biopsy to confirm the diagnosis is mandatory.
Vulvar Intraepithelial Neoplasia VIN is associated with HPV infection and is increasing in frequency, particularly among young women (see Chapter 19). Diagnosis requires biopsy of any suspicious vulvar lesions, particularly those that are pigmented or discolored. The increasing frequency of this entity dictates a careful vulvar inspection during annual gynecologic examinations.