Frictional keratosis of the vestibule

Frictional keratoses of the
vulva
SP Manam, FM Lewis, EJ Calonje, SM Neill
St Johns Institute of Dermatology London
Case 1
22 year old female, who was a keen runner , was
referred for a long-standing vulval lesion
Biopsy showed
hyperkeratosis and
acanthosis with little
inflammation
2 years later, she
fractured her ankle and
was unable to run for
several months.
The lesion almost
completely resolved at
this time.
Hyperkeratotic whitened patch at anterior vestibule
Resolution of the
hyperkeratosis of the plaque
at the anterior vestibule
Case 2
An 18 year old marathon runner with lichen
sclerosus treated previously
Biopsy of the area showing hyperkeratosis, acanthosis and
some mild dermal scarring (H&E x40)
Architectural change of old lichen sclerosus with a
macerated and fissured hyperkeratotic plaque at the
fourchette.
The area improved with emollients and a
moderately potent steroid
Cases 3&4
A 23 year old female was a keen runner and
netball player, presented to the clinic with this
lesion.
Vulval examination a white plaque straddling the inner
aspects of the labia minora.
A 30 year old female, who was a keen middle
distance runner, was referred from the
Genitourinary clinic with this lesion.
A small white hyperkeratotic plaque on the upper inner
aspects of the labia minora.
Case 5
A 41 year old lady was referred for an
asymptomatic perineal plaque.
Closer questioning revealed that she
ran twice a day.
The histology of Cases 3, 4 and 5
showed no evidence of VIN, only
acanthosis and hyperkeratosis.
White plaque on the perineum
Discussion
Mucosal hyperkeratosis occurs when there is irritation
causing increased production of keratin. This leads to a
change in the thickness and colour of the mucosa. There are
similar findings to our vulval cases in the oral mucosa when
there is constant irritation from cheek biting or vigorous
brushing of the teeth. This commonly resolves within a few
weeks if the friction is removed.
Frictional keratosis is
important to recognize.
Biopsy is essential to exclude
VIN, hypertrophic lichen
planus and white sponge
naevus as the clinical
appearances can be similar.
Management includes
emollients regularly before
intense exercise and mild
topical steroids if
symptomatic.
Cases of vulval hyperkeratosis occurred at sites of increased
friction
-anterior vesitbule
-inner aspect of the labia minora
-fourchette
in women whose sporting activity involved exercise with
repeated movement exerting same frictional forces on the
mucosa.
Reduction in exercise will also
aid resolution of plaques.