Vulvar Syringoma – A rare distribution of a common entity
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A syringoma is a benign adnexal tumor arising from eccrine sweat glands, typically found on the face, specifically the periorbital area. Vulvar syringomas are not very common, and occurrence without extragenital involvement is a rarer event. Vulvar syringomas need to be differentiated from papular eruptions occurring on the vulva. Histopathological examination may be needed to differentiate them from one another.

Patient 1 is a 38-year-old woman who presented with multiple asymptomatic skin-colored papules on her labia majora for 10 months. Patient 2 is a 31-year-old woman who presented with itchy flesh-colored papular lesions on her labia majora present for 10 years. Neither patient had similar appearing lesions elsewhere on their body.

Histopathology of the lesion from both the patients showed multiple cystically dilated glands lined by two-layered epithelium with luminal secretions and compressed tadpole-shaped tumor islands surrounded by fibrocollagenous tissue in the dermis. A diagnosis of vulvar syringoma was made.

They are frequently seen in middle-aged women as multiple skin-colored to yellowish asymptomatic papules measuring 1–5 mm in diameter. Syringomas of the genitalia are rare but may usually occur as a part of a more generalized distribution. Isolated genital occurrence is considered to be rare. In addition, vulvar syringomas may be associated with pruritus more so during summer and menses.

In 18 patients with vulvar syringoma, one-third had extragenital involvement and 72% had associated pruritus. Syringomas may be influenced by hormones as they increase in size during pregnancy, in the premenstrual period and with the use of oral contraceptives.

There are limited treatment options for vulvar syringoma. In asymptomatic patients, the treatment is aimed at cosmetic improvement. Various topical agents such as corticosteroids, tretinoin, and tranilast have been tried with variable results. Alternatives include electrocautery, cryotherapy, carbon dioxide laser, and surgical excision. Vulvar syringoma is an underreported entity, likely to be missed or misdiagnosed and is in the differential of papular vulvar eruptions.