VULVITIS? 'ZOOM' PLASMA CELL *itching*

[Guest guest]

HI all,

This almost sounds like Lichen Sclerosis since they mention intractable itching with it too. I believe in males there is a disease called Zoom Balanitis too.

This is by Dr. A. Goldstein whom we know. (w. photos)

Dee~

Dee Troll

VIGNETTES

Vol. 141 No. 6, June 2005

Plasma Cell Vulvitis: A Rare Cause of Intractable Vulvar Pruritis

In 1955, Zoon1 described a benign condition of the vulva that was characterized by erythematous plaques composed of predominantly plasma cells. Since his initial case report, there have been 32 additional cases reported, using 3 synonyms: plasma cell vulvitis (PCV), Zoon vulvitis, and vulvitis circumscripta plasmacellularis.2-3

The most common symptoms associated with PCV are pruritis *itching*, pain, burning, and dyspareunia.2

While some case reports describe conservative medical treatments that have been effective, we report a case of PCV that was recalcitrant to all treatments except surgical resection.

Report of a Case

A 28-year-old woman presented to a referral center for vulvovaginal diseases with a 3-year history of intractable pruritis that was localized to the vulvar vestibule. She also complained of intermittent introital dyspareunia. She had been treated with fluconazole, terconazole, clobetasol, estradiol, and intralesional triamcinolone, without symptom relief. (Sound familiar? DT)

Colposcopic examination of the vulva revealed a glistening plaque in her vulvar vestibule (Figure 1). A biopsy specimen of the lesion demonstrated spongiosis and a lichenoid infiltrate containing a predominance of plasma cells (Figure 2). Her symptoms and the histologic features were consistent with the diagnosis of PCV.

She underwent a series of 6 intralesional injections of recombinant interferon alfa-2b (Intron A), without improvement in her symptoms. She then underwent surgical resection of the lesion and has remained symptom-free since then.

View larger version (106K):[in this window][in a new window]

Figure 1. Shiny, erythematous plaque in the vulvar vestibule.

View larger version (214K):[in this window][in a new window]

Figure 2. Infiltrate consisting of plasma cells and lymphocytes (hematoxylin-eosin, original magnification x100).

Comment

Plasma cell vulvitis is a rare cause of intractable vulvar pruritis. (itching)

The physical findings consist of atrophic, glistening, erythematous plaques or patches. Infrequently, there can be erosions or areas of friability.

Histologic examination reveals a lichenoid infiltrate that is composed of plasma cells and lymphocytes. Additional findings include "diamond-shaped" keratinocytes, vascular dilatation, and intracellular edema. Hemosiderin deposits give the lesions their characteristic red or brownish color.2, 4

While the etiology of PCV is unknown, authors have suggested that trauma, chronic irritation, or an autoimmune response to an unidentified mucosal antigen may play a role in the pathogenesis of this disorder.4

Response to therapy is inconsistent. Reported treatments usually include estrogens, topical and intralesional corticosteroids, antifungal agents, antibiotics, fulguration, caudal nerve blocks, laser ablation, cryotherapy, interferon alfa, etretinate, and surgical resection.2, 5

In the present case, several conservative methods of treatment failed before the patient underwent successful surgical resection.

The differential diagnosis of these erythematous lesions should include Paget disease, pemphigus vulgaris, lichen planus, (I would add Lichen Sclerosus too, dee) fixed drug eruption, squamous carcinoma, and herpes simplex infection.4 The diagnosis of PCV should be considered in any patient with an erythematous lesion and intractable vulvar pruritis that is nonresponsive to treatment with topical steroids.

AUTHOR INFORMATION

Correspondence: Dr Goldstein, The Center for Vulvovaginal Disorders, 908 New Hampshire Ave NW, Suite 200, Washington, DC 20037 (obstetrics@...

).

Financial Disclosure: None.

Acknowledgment: We gratefully acknowledge the help provided by Sroden, MD, The s Hopkins Hospital, Baltimore, Md.

T. Goldstein, MD; Kurt , MD; Lara J. Burrows, MD

1. Zoon J. Balanitis and vulvitis plasmacellularis. Dermatologica. 1955;111:157.

2. L, Massey K. Plasma cell vulvitis and response to topical steroids: a case report. Int J STD AIDS. 2003;14:568-569. CrossRef | ISI | MEDLINE

3. Salopek TG, Siminoski K. Vulvitis circumscripta plasmacellularis (Zoon's vulvitis) associated with autoimmune polyglandular endocrine failure. Br J Dermatol. 1996;135:991-994. CrossRef | ISI | MEDLINE

4. McCreedy CA, Melski JW. Vulvar erythema: vulvitis chronica plasmacellularis (Zoon's vulvitis). Arch Dermatol. 1990;126:1352-1356. CrossRef | ISI | MEDLINE

5. JB, Im DD, -O'Brien E, Rosenshein NB. Etretinate: therapy for plasma cell vulvitis. Obstet Gynecol. 1998;92:706. FULL TEXT

Arch Dermatol. 2005;141:789-790.

Source: http://archderm.ama-assn.org/cgi/content/full/141/6/789?ct

1. Anything suggested on this site or opinions offered are not intended to be medical or pharmaceutical advice or otherwise take the place of your physicians orders, nor to diagnose or treat your specific health problems. Please discuss all methods of treatment with your practitioner. 2 *****WARNING: Flames and inappropriate treatment of other members on this list will NOT be tolerated.To contact Dee, owner & moderatorDTroll@... To contact assistant moderator chriscappo@... To contact Lanya, assistant moderator luolanya@...