What are the other Names for this Condition? (Also known as/Synonyms)

• IFK of Vulva
• Inverted Follicular Keratosis of Vulvar Skin
• Vulvar Inverted Follicular Keratosis

What is Inverted Follicular Keratosis of Vulva? (Definition/Background Information)

• Seborrheic keratosis is a very common, benign tumor of skin that resembles a wart. It is associated with itching, which may result in ulceration and bleeding from intense scratching
• Inverted Follicular Keratosis (IFK) of Vulva is a subtype of seborrheic keratosis that is seen in the vulva (area around the external opening of vagina) in adult women
• It is differentiated from seborrheic keratosis on a tissue biopsy, when examined by a pathologist under the microscope. In Inverted Follicular Keratosis of Vulva, the pathologist will note the presence of ‘squamous eddies’
• The cause of development and risk factors for Inverted Follicular Keratosis of Vulva are presently unknown. The lesions are not caused by any infection
• A treatment of Inverted Follicular Keratosis of Vulva may be undertaken, if they present cosmetic concerns to the individual. In such cases, a simple surgical excision is sufficient treatment. The prognosis is excellent on removal of the tumor

Who gets Inverted Follicular Keratosis of Vulva? (Age and Sex Distribution)

• Inverted Follicular Keratosis of Vulva is rare and observed in adult women
• This condition is observed worldwide across all racial and ethnic groups
• However, lighter-skinned individuals (especially Caucasians) are more prone to seborrheic keratosis than darker-skinned individuals (such as Asians, Africans, etc.)

What are the Risk Factors for Inverted Follicular Keratosis of Vulva? (Predisposing Factors)

Presently, no specific risk factors for Inverted Follicular Keratosis of Vulva have been identified. However, in general, the risk factors for seborrheic keratosis include:

• Exposure to sunlight and UV light
• Skin tanning (use of tanning beds)
• Caucasians (fair-skinned) are more vulnerable compared to individuals of other ‘dark-skinned’ races

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Inverted Follicular Keratosis of Vulva? (Etiology)

• The exact cause and development of Inverted Follicular Keratosis of Vulva is unknown
• Even though these tumors resemble warts, they are not caused by a viral infection

What are the Signs and Symptoms of Inverted Follicular Keratosis of Vulva?

In most cases, Inverted Follicular Keratosis of Vulva does not present any signs and symptoms. However, the following may be noted:

• They occur as single or multiple tiny skin overgrowths in the vulvar region; the lesions may be externally/physically visible
• The lesions may be dark-pigmented or have a fleshy appearance
• They are slow-growing tumors that may range in size from a few mm to up to 3 cm
• Typically, seborrheic keratosis has a “stuck on the skin” appearance (papular lesions) and have well-defined boundaries
• The nodules are benign and no malignancy occurs in them, even though they may be confused with melanoma (a malignant skin tumor)
• Seborrheic keratosis is associated with itching, which can lead to constant scratching, a condition known as irritated seborrheic keratosis. This can result in inflammation and bleeding

How is Inverted Follicular Keratosis of Vulva Diagnosed?

A diagnosis of Inverted Follicular Keratosis of Vulva may involve the following procedures and tests:

• Complete physical examination with evaluation of medical history
• Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Skin biopsy: A skin biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Note: The diagnosis of Inverted Follicular Keratosis of Vulva may not necessarily involve a biopsy. However, if there is a suspicion of melanoma (due to increased and irregular pigmentation), then the healthcare provider may recommend a biopsy.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Inverted Follicular Keratosis of Vulva?

No significant complications generally arise from Inverted Follicular Keratosis of Vulvar Skin; however, the following may be observed:

• These wart-like growths may present cosmetic concerns, in which case a surgery may be proposed
• If they are traumatized, severe pain and bleeding with ulceration may occur
• Bleeding and ulceration can cause secondary infection due to bacteria or fungi
• Post-surgical infection at the wound site is a potential complication

How is Inverted Follicular Keratosis of Vulva Treated?

Inverted Follicular Keratosis of Vulva may not require any treatment in a majority of cases. However, in case they present cosmetic issues to the individual, they may be removed.

• The healthcare provider may chose to regularly monitor the tumor, if they are asymptomatic. A ‘wait and watch’ approach may be adopted
• A complete surgical excision can help result in a cure
• Follow-up care with regular screening and check-ups are important

How can Inverted Follicular Keratosis of Vulva be Prevented?

Current medical research has not established a definitive method of preventing the formation of Inverted Follicular Keratosis of Vulva.

What is the Prognosis of Inverted Follicular Keratosis of Vulva? (Outcomes/Resolutions)

• The prognosis of Inverted Follicular Keratosis of Vulva is excellent on its complete excision and removal
• Since, these are benign tumors, the prognosis is excellent even if no treatment is provided and only periodic observation is maintained

Additional and Relevant Useful Information for Inverted Follicular Keratosis of Vulva:

• Seborrheic keratosis is not an infectious condition; it does not spread from one individual to another
• There is no definitive proof that consuming certain foods influence its development