Zoons Vulvitis Plasma Cell Vulvitis

There is some doubt whether plasma cell vulvitis (PCV) is a distinct clinicopatholo-gical entity as many of the reports in females of Zoon's are probably LP (14). A plasma-cell-rich infiltrate in a vestibular biopsy may be a misleading finding because plasma cells are commonly found in inflammatory conditions of the vestibule because it is a mucosal epithelium, so PCV is probably not a single disease entity but represents a reaction pattern to other inflammatory conditions such as LP (Fig. 9A and B). The criteria needed to make the diagnosis have varied in the literature and the essential histological features include epidermal thinning, absent horny and granular layers, and distinctive lozenge-shaped keratinocytes with widened intercellular

Table 3 Lichen Planus

Diagnosis

Clinical Differential

Symptoms appearance diagnosis

Therapy

Lichen planus Itch, pain if Lesions may be

Lichen sclerosus, mucous membrane pemphigoid, VIN, extra-mammary Paget's and Hailey-Hailey disease.

Potent topical steroids as ointments, foams, or suppositories. Oral steroids may be required for severe disease.

eroded; papulosqua-

dyspareunia if mous, eroded, vestibular ulcerated, involvement; pigmented vaginal macules; there discharge and is often post-

postcoital inflammatory bleeding if pigmentation vaginal and scarring involvement

In steroid-resistant disease topical pimecrolimus or tacrolimus.

Second-line treatment includes azathioprine, methotrexate, and retinoids. Blunt dissection to open up stenosed vagina.

Severe Vulvar Lichen Sclerosus

Figure 9 (A) Plasma cell vulvitis of Zoon—a dense inflammatory infiltrate is seen in the dermis, composed predominantly of plasma cells. (B) Plasma cell vulvitis of Zoon—higher power shows the dense plasma cell infiltrate. This condition is often seen in association with other conditions. In this case, there was also an active herpes infection.

Figure 9 (A) Plasma cell vulvitis of Zoon—a dense inflammatory infiltrate is seen in the dermis, composed predominantly of plasma cells. (B) Plasma cell vulvitis of Zoon—higher power shows the dense plasma cell infiltrate. This condition is often seen in association with other conditions. In this case, there was also an active herpes infection.

spaces; while in the dermis there is a dense inflammatory infiltrate composed largely of plasma cells with dilated blood vessels and abundant hemosiderin. Clinically, the lesions are fixed erythematous patches with a varnished appearance. The majority of the reports of this condition in women describe the lesions in the vestibule and labia minora, whereas the typical site in men is the glans and prepuce. The glans clitoris seems to be rarely, if ever, affected.

Treatment: Topical steroids help if the changes are because of LP but if the lesions are fixed, the topical steroids have little effect. Patients often complain of pain and topical 5% lidocaine can be used. Irritancy may play a role if the barrier function of the epithelium is impaired and the addition of a barrier ointment may be useful (Table 4).

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Responses

  • teigan
    How many cases of zoons vulvitis are there?
    4 years ago
  • Marcel
    What is Zoon's Vulvitis?
    3 years ago

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