Vesicular Lesions on the Vulva
A 45-year-old woman presented with a 5-year history of pruritic, exudative lesions in the vulvar area. The lesions had slowly grown in number and size over the years. The patient had been previously clinically diagnosed as having condylomata acuminata and had been treated with imiquimod, trichloroacetic acid, and podophyllin, with no effect. Eight years earlier, she had undergone a partial hysterectomy and radiation therapy for cervical cancer, with resultant chronic lymphedema of the left lower extremity.
Physical examination revealed a firm, woody induration of the mons pubis, labia majora, and left lower extremity. Multiple erythematous, firm papules were noted on the mons pubis and the labia majora, and translucent vesicles with clear fluid were seen bilaterally on the labia majora (Figure 1). A 4-mm punch biopsy specimen was obtained from the right labium majus (Figure 2 and Figure 3).
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Ashish Bhatia, MD, Web Editor, Archives of Dermatology.