Acantholytic dermatosis localized to the vulvocrural area

This report describes 6 women with acantholytic lesions localized to the vulvocrural area. Clinically, multiple papules or solitary papules or plaques were situated on the labia majora or adjacent skin. None of the patients had similar abnormalities elsewhere on the body or family histories of similar eruptions. Two patients had concurrent candidal vaginitis. Microscopic findings consisted of acantholytic dyskeratosis resembling that observed in Darier's disease or acantholysis with minimal dyskeratosis similar to that seen in Hailey-Hailey disease. In one patient, acantholytic dyskeratosis with a cup-like configuration resembled the microscopic appearance of warty dyskeratoma. Immunofluorescence microscopy was negative in one patient. Solitary lesions were cured by local excision, but the papular eruption of one patient was recalcitrant to therapy. The literature contains descriptions of eight additional women with comparable lesions. Acantholytic reactions localized to the vulvocrural area are not apparently rare and need to be distinguished from other acantholytic dermatoses that can affect this anatomic site.