Treatment of Vulvar Fordyce Adenitis
Vulvar Fordyce adenitis should be treated with oral isotretinoin for cases unresponsive to first-line therapy, as this achieved complete remission in patients who failed tetracyclines. 1
Understanding the Condition
Vulvar Fordyce adenitis (previously called vulvar sebaceous adenitis or vulvar acne) is a distinct inflammatory condition affecting the labia minora and inner labia majora, characterized by:
- Recurrent painful papules, pustules, or nodules on the labia minora (91% of cases) and inner labia majora (42% of cases) 1
- Suppuration in approximately half of patients 1
- Pitted scarring in some cases 1
- Median diagnostic delay of 6.5 years, indicating this is frequently misdiagnosed 1
- Neutrophilic infiltrates within or around Fordyce sebaceous glands on histopathology 1
Treatment Algorithm
First-Line Therapy
- Tetracyclines should be initiated as first-line treatment, though efficacy is inconsistent 1
- Oral zinc can be added to tetracyclines, though this combination is not consistently effective 1
Second-Line Therapy for Refractory Cases
- Isotretinoin is the definitive treatment for patients who fail to respond to tetracyclines, achieving complete remission in documented cases 1
- The rationale is to reduce inflammation and decrease sebaceous gland secretion using an oral anti-acne therapeutic strategy 1
Clinical Associations to Evaluate
When managing vulvar Fordyce adenitis, assess for:
- Acne vulgaris: Present in 65% of patients where data were available (17 of 26 cases) 1
- Hidradenitis suppurativa: Observed in 3 cases, suggesting potential overlap in pathophysiology 1
- Androgenic conditions: Rarely associated (androgenic alopecia and hirsutism each in 1 case) 1
Important Clinical Pitfalls
- Do not confuse with infectious vaginitis: This condition affects the labia minora/inner labia majora (sites of Fordyce granules), not the vaginal mucosa, and has a distinct inflammatory rather than infectious pathophysiology 1
- Avoid premature discontinuation of therapy: Given the median 6.5-year diagnostic delay, patients may have suffered unnecessarily; ensure adequate treatment duration 1
- Recognize the pattern: The location on labia minora and inner labia majora (coinciding with Fordyce granule distribution) is pathognomonic and should prompt consideration of this specific diagnosis rather than generic vulvar dermatoses 1