Hirsutoid condylomata ofvulva 
Case report 
HIRSUTOID PAPILLOMATOSIS-LIKE 
CONDYLOMATA OF THE VULVA 
P. Belloma, F. Barduagni, P. Donati and L. Valenzano 
SUMMARY 
Condylomata acuminata of the vulva clinically mimicking hirsutoid papillomas in a 80-year-old female are reported. 
Immunohistochemical assays with monoclonal antibodies directed against the human papilloma virus (HPV) as well as the in 
situ hybridization, which was positive for types 6/11, confirmed the clinical diagnosis. The treatment with 0,5% podophyllotoxyn 
was successful. 
KEYWORDS 
condylomata acuminata, vulva, hirsutoidform, podophyllotoxyn 
INTRODUCTION 
Hirsutoid papillomatosis is a benign condition sometimes 
observed on the glans penis. It is expressed as dome-shaped 
or hair-like papules , chiefly between the ages of 20 and 50. 
Histologically, the lesions consist of normal connective tissue 
covered by an epidermis which is acanthotic at the periphery. 
Similar lesions have been described in females as hirsutoid 
papillomas of vulva (1). 
However, condylomata acuminata provoked by Human pa-
pillorna viruses (HPV) which imitate hirsutoid papillornatosis 
have been described (2,3). 
CASEREPORT 
A healthy 80-year-old Caucasian female was seen with 
numerous filliform white papules located on her labia 
acta dermatovenerologica A.P.A . Vol 5, 96, No 1 
minora and on the introitus vaginae (Fig. 1). The patient 
excluded inflammatory processes in the genital area in the 
past 10 years and further denied any sexual intercourse 
in the past 20 years. Her medical history was unremar-
kable and she did not take any medication. Routine inve-
stigations, including hematological and biochemical tests, 
were normal. 
She complained of recalcitrant and severe itching, a buming 
sensation and secretion in the area affected. 
Two biopsy specimens obtained from papular lesions of 
the labia minora were processed for light microscopy. 
Histopathology revealed hyperkeratosis, acanthosis and 
papillomatosis. In the stratumMalpighii numerous partially 
atypical koilocytes were present. A mild perivascular 
inflammatory infiltrate was also noted (Fig. 2). 
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Hirsutoid condylomata o/vulva 
The immunohistochemical investigation using mono-
clonal antibodies directed against HPV (anti HPV Ortho) 
was positive. PCR and the in situ hybridization revealed 
viral DNA fragments specific for HPV 6/11. Thus the 
diagnosis of condylomata acuminata was confirmed. 
The patient was efficiently treated by topical application 
of 0.5% podophyllotoxyn in ethanol for four weeks. After 
12 months no relapse of the disease was noted. 
Figure l. Clinical appearance ofthe lesions. 
32 
DISCUSSION 
Condylomata acuminata are probably the most frequently 
observed sexually transmitted disease ofthe ano-genital area. 
Hirsutoid papillomatosis appears more frequently in males, 
but has been described also in women on the vulva (4,5). It 
is especially rare in elderly women not practicing sexual 
intercourse. In certain instances condylomata acuminata may 
look similar to hirsutoid papillomatosis, so that the diffe-
rential diagnosis is not possible on purely clinical basis. 
For these reasons we believe that this short presentation 
of such a case deserves to be shortly reported. 
Figure 2. Histologicalfindings: acanthosis, papillomatosis, 
parakeratosis with koilocytosis. 
acta dennatovenerologica A.P.A. Vol 5, 96, No 1 
Hirsutoid condylomata ofvulva 
REFERENCES 
1. Kohdah L, Minoy Y, Fukuda M. Hirsutoid papillomas of 
the vulvae. J Dennatol 1986; 13: 154-65. 
2. Tribbia G, Crescini C, Pezzica E, et al. Patologia vulvare 
da HPV. Lesioni clinicamente inapparenti. Chron Dermatol 
199 1; 1: 107-13. 
3. Growdon WA, Fu SY, et al. Pruritic squamous papillo-
matosis: evidence far human papillomaviruses infection. 
Obstet Gynecol 1985; 66: 564-68. 
4. Altmeyer P, Chilf GN, Holzman H. Hirsuties papillaris 
vulvae (Pseudokondylome der Vulva), Hautarzt 1982; 33: 
281-3. 
5. Di Paola G, Rueda ND. Deceptive vulvar papillomavirus 
infection: a possible explan ation for keratin cases of 
vulvodynia. J ReprudMed 1986; 31: 966-70. 
6. Donati P, Amantea A, Capitanio B, Venturini D. La 
papillomatosi irsutoide della vulva. Dermatologica Oggi 
1992; 7: 12-3. 
AUTHORS' ADDRESSES 
Pierpaolo Belloma MD, Dermatologist, Instituta Dermatologico S, Gallicano, Via S. Gallicano 25 A, 00153 Roma, Italia 
Francesca Barduagni MD, Research Fellow, Clinica Dermatologica, University, La Sapienza, Roma, Italia 
Pietro Donati MD, Dermatohistopathologist, Instituta Dermatologico S. Gallicano 
Luigi Valenzano MD, Day Hospital, Instituta S. Gallicano 
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