Vulval acne: a case series describing clinical features and management

Clin Exp Dermatol. 2021 Mar;46(2):319-323. doi: 10.1111/ced.14424. Epub 2020 Sep 25.


Intermittent inflammation of the vulval pilosebaceous units is common and usually self-limiting, but some patients experience recurrent and more troublesome symptoms. There is a scarcity of information on this problem. We describe the clinical and histological features in these patients and the response to treatment. A retrospective, observational study of 16 patients with this phenomenon of recurrent, protracted folliculocentric inflammation of the vulval pilosebaceous unit was performed. Details on the clinical features, histology and response to treatment were collected. Mean age at presentation was 32 years (range 21-45). All patients reported recurrent painful papules and pustules on the labia majora and labia minora. Nine patients reported a cyclical pattern to the development of lesions, with premenstrual exacerbation being most common. Histological examination of these lesions showed a folliculocentric microabscess formation surrounded by an acute and chronic inflammatory cell infiltrate, with a focal foreign-body granulomatous reaction. All our patients responded well to tetracycline, antiandrogenic or retinoid therapy. We propose the term 'vulval acne' for this condition and propose a stepwise approach to its management. We hope to highlight this as a common but underreported entity.

Publication types

  • Observational Study

MeSH terms

  • Acne Vulgaris / diagnosis*
  • Acne Vulgaris / drug therapy
  • Adult
  • Angiogenesis Inhibitors / therapeutic use
  • Biopsy
  • Disease Progression
  • Drug Therapy, Combination
  • Female
  • Humans
  • Inflammation / pathology*
  • Middle Aged
  • Protein Synthesis Inhibitors / therapeutic use
  • Recurrence
  • Retinoids / therapeutic use
  • Retrospective Studies
  • Tetracycline / therapeutic use
  • Treatment Outcome
  • Vulvar Diseases / pathology*


  • Angiogenesis Inhibitors
  • Protein Synthesis Inhibitors
  • Retinoids
  • Tetracycline