Vulval papules: what causes them?

Contrary to pustules, papules are small bumps that do not contain any fluid. They typically measure less than 5 millimetres in diameter. Their colour can range from pale pink to dark red, and they can be asymptomatic or cause itching or pain. The papules can form on various areas of the vulva, including the labia majora and labia minora, and can be caused by multiple factors.

• A local irritation.

  Most commonly, vulvar papules result from local irritation. This can, for instance, be due to wearing overly tight underwear or participating in certain sports, such as cycling or horse riding, which are likely to cause repeated microtraumas to the vulva and a slight inflammatory reaction in the form of small red or pink papules. Certain shower gels or laundry detergents, particularly those containing alcohols or perfumes, can also irritate this sensitive area and trigger a local immune response, resulting in the emergence of vulvar papules.

  Another common cause of irritation is pubic shaving. Indeed, when performed dry or without a suitable shaving product, it can lead to micro-cuts. These can become entry points for bacteria, subsequently causing an inflammation of the hair follicles in the form of red papules. It should be noted that ingrown hairs that may appear after hair removal can also lead to the formation of papules.

• A condyloma.

  Also known as genital warts, condylomas present as small, rough growths, often clustered together and generally painless. These papules are caused by certain strains of the human papillomavirus and are primarily transmitted through sexual contact. Although benign, condylomas can be a source of aesthetic or functional discomfort. Chemical treatments, such as with trichloroacetic acid, physical treatments, using lasers or cryotherapy, or surgical treatments, by excision, can eliminate them. However, regardless of the chosen method, the recurrence rate is quite high, ranging between 30 and 60%.

• A molluscum contagiosum.

  This viral infection caused by a poxvirus manifests itself through round and firm papules, often presenting a small depression at their centre. These lesions are generally flesh-coloured or slightly pink and measure between 2 and 5 millimetres in diameter. Molluscum contagiosum is contagious and is usually transmitted through direct contact. Although these papules are benign and cause neither itching nor pain, they can persist for several months without treatment. Various topical medications can be used to get rid of molluscum contagiosum papules, such as trichloroacetic acid, tretinoin or tazarotene. They can also be treated by cryotherapy, burned with a laser or electric current, or surgically removed.

• Genital herpes.

  Genital herpes, caused by the herpes simplex virus, is a sexually transmitted infection that initially presents as painful red papules that quickly evolve into fluid-filled vesicles. These lesions then rupture to form painful ulcers before healing. The virus can remain latent in the body and cause recurrences during periods of stress or immunosuppression. Currently, there is no treatment or vaccine for genital herpes, but antiviral medications can help to alleviate the pain caused by the lesions and control recurrences.

• A seborrheic wart.

  Seborrheic warts are benign skin growths that appear with age. They occur primarily after the age of 50, typically on the face, shoulders or chest. The formation of seborrheic warts in the genital region is rare, but possible. Quite similar to fibrous papules, these bumps are the result of the proliferation of epidermal cells and are completely harmless. While it is possible for the wart to fall off by itself, intervention through cryotherapy or CO2 laser ensures its removal.

• A pendulous molluscum.

  Also known as soft fibromas, the papules resulting from a molluscum pendulum are often flesh-coloured and quite soft. They are frequently found in skin folds, due to the friction experienced in these areas. Soft fibromas are more common in people with insulin resistance, even though the underlying mechanisms are not yet fully understood. Neither malignant nor contagious, the papules caused by a molluscum pendulum can be bothersome as they can easily "catch", on underwear for example. These bumps can easily be removed by cryotherapy with liquid nitrogen, by performing an ablation, or by electrodessication.

• Folliculitis.

  Appearing on areas of the body where hair is present, folliculitis is an inflammation of the hair follicles caused by a bacterial infection, often due to Staphylococcus aureus, or a fungal infection. On the vulva, this inflammation takes the form of small red papules surrounding the base of the hairs, which can be painful and filled with pus. Folliculitis is frequently linked to a poor shaving technique that interferes with the trajectory of hair growth and goes hand in hand with problems of ingrown hairs. The treatment of folliculitis often relies on the use of topical antibiotics, such as mupirocin or clindamycin, for several days.

• The pearly papules.

  Most commonly found on the glans, pearly penile papules can also appear on the vulva. These are small skin protrusions, symmetrically arranged on the labia minora. These papules, often white or flesh-coloured, are actually enlarged sebaceous glands. Their smooth texture and symmetrical arrangement distinguish them from pathological lesions. Pearly penile papules are considered a normal anatomical variation and do not require treatment. However, for aesthetic reasons, it is possible to remove them. This is usually done by CO2 laser or by electrocoagulation.