Plasma Cell Vulvitis N76.3

Rare, benign inflammation of the vulva corresponding to balanoposthitis chronica circumscripta plasmacellularis. It is significantly less common in women than in men.

Unknown; it is believed to be an unspecific reaction to a chronic irritation.

Middle-aged or older women; often beyond the menopause.

Usually well defined, but more often diffuse, brown-red or deep red, burning, painful lesions that can occur in the mucosa of the entire vulva.

The clinical picture is generally characterised by a previous, decided resistance to therapy.

In most cases, colpitis plasmacellularis is present on the same side, which must be clinically distinguished from trichomoniasis.

Epidermis atrophically flattened with missing horny and granular cell layer. Edema of the stratum papillare, dilatation of the capillaries in the upper corium, partial erythrocyte extravasation; haemosiderin deposits; band-shaped diffuse lymphohistiocytic infiltrate (also eosinophilic and neutrophil granulocytes) with varying density of plasma cells (>50%). Remark: The occurrence of plasma cells is not a specific feature of vulvitis (or balanitis) "plasmacellularis" but is to be understood as a local typical inflammatory reaction of the mucosa.

Clinical presentation with a sharply defined, deep-red plaque. 

Histology (consistent with plasma cell balanitis ). Plasma cell infiltration of the mucosa. 

Trichomoniasis: usually accompanied by a thin, yellowish discharge rich in granulocytes.   

Atrophic vulvitis: predominantly parabasal cells on direct microscopy.

Erosive lichen planus: usually combined with lichen planus in other locations; histology is diagnostic

Group A streptococcal vulvitis: acute symptoms; pathogen detection

VIN (erythroplasia; Bowen’s disease): Clinical presentation is minimally symptomatic. Usually an incidental finding. Histology is diagnostic. 

 

Avoid triggering cause (usually chronic inflammation, trauma, mechanical irritation). Optimization of hygienic measures and keeping dry. Exclusion of concomitant diseases, e.g. candida, trichomonads, worm infections.

Therapy trial with fatty glucocorticoid-containing topicals (Rp.:1% hydrocortisone in a Deumovan® base). Limited temporal application(Cave! note steroid side effects).

Seated baths with addition of potassium permanganate (light pink) or synthetic tanning agents (e.g. Tannolact, Tannosynt).

Some authors recommend a systemic therapy with clindamycin (4x300mg for 10 days).

If the patient is resistant to therapy, surgical treatment options with the CO2 laser or with the help of cryosurgery are possible.

1. dos Reis HL et al. (2013) Zoon vulvitis as a differential diagnosis in an HIV-infected patient: a short report. J Int Assoc Provid AIDS Care 12:159–161
2. Fernández-Aceñero MJ et al. (2010) Zoon’s vulvitis (vulvitis circumscripta plasmacellularis). Arch Gynecol Obstet 282:351–352
3. Krapf JM et al. (2021) Plasma Cell Vulvitis: A Systematic Review. J Low Genit Tract Dis 25:312–317.
4. Sattler S et al. (2021) Plasma cell vulvitis: A systematic review. Int J Womens Dermatol 7:756-762