Vestibular papillomatosis is a normal anatomical variant of the vestibular mucosa of the vulva characterized by multiple tiny, soft, smooth, pink papules with a linear configuration and/or symmetric distribution appearing on the mucosa of the vestibule and inner labia minora. The papules are usually asymptomatic, although some patients have reported vulvar pruritus and dyspareunia. The papules usually develop after puberty.
This normal variant is thought to occur in approximately 1% of women, although some studies have found an incidence rate of up to one-third or more.
Papillomatosis of the vulvar vestibule has been reported under a variety of names: vestibular papillae, vulvar squamous papillomatosis, hirsutoid papillomas of the vulvae, and micropapillomatosis.
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Synopsis
Codes
ICD10CM:
D28.0 – Benign neoplasm of vulva
SNOMEDCT:
18985003 – Vestibular papillomatosis
D28.0 – Benign neoplasm of vulva
SNOMEDCT:
18985003 – Vestibular papillomatosis
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Condyloma acuminatum – Lesions are randomly distributed and not limited to the vestibule; they are firm, and the filiform or cauliflower projections tend to coalesce at the base. Due to having their origin mainly from HPV-related changes, condyloma will have aceto-whitening changes visualized during vulvoscopy.
- Lichen planus – Although frequently part of a generalized disease, lichen planus can be localized to mucosal surfaces including the vaginal mucosa; linear lacy markings (Wickham striae) are common in lichen planus but not in vestibular papillomatosis.
- Syringoma
- Molluscum contagiosum
- Fordyce spots – Tiny, yellow papules representing sebaceous glands opening onto the mucosa.
Best Tests
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Management Pearls
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Therapy
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References
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Last Reviewed:10/24/2018
Last Updated:07/09/2023
Last Updated:07/09/2023
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