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Moll I. Balanitis circumscripta plasmacellularis Zoon. Aktuelle Dermatologie 2021. [DOI: 10.1055/a-1485-4596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ZusammenfassungDie Balanitis plasmacellularis Zoon (BPZ), zuerst beschrieben von J. J. Zoon, ist eine chronische entzündliche Dermatose, die histologisch definiert ist anhand eines subepithelialen, lymphohistiozytären Infiltrates mit vielen Plasmazellen. Dabei wurden ein Spektrum epithelialer Veränderungen und eine variable Zusammensetzung des Infiltrates beschrieben. Dadurch unterscheidet sie sich von der Erythroplasie Queyrat, obwohl beide klinisch sehr ähnlich sind. An der BPZ erkranken vorwiegend ältere, nicht zirkumzidierte, heterosexuelle Männer. Klinisch typisch sind scharf umschriebene, rötlich-glänzende Rundherde an der Dorsalseite der Glans mit Übergang auf den Sulcus und das innere Präputialblatt. Erosionen und flache Infiltrate können hinzukommen. Der Verlauf ist chronisch mit sehr geringen Beschwerden, etwas erhöhte Empfindlichkeit wird oft genannt. Die Pathogenese ist unklar. Barrierestörung und Infektionen, unterhalten durch Feuchtigkeit, Mangel an Hygiene, Traumata und Irritationen, werden diskutiert. Dafür spricht auch das spontane Abheilen nach Zirkumzision oder lokalen Therapien mit Mucipirocin oder Fusidinsäure. Lokale Steroide sind ebenfalls – wie in unserem Fall – effektiv. Eine proaktive Therapie mit Tacrolimus-Salbe scheint eine Option. Die plasmazelluläre Entzündung ist nicht auf das männliche Genitale beschränkt, auch eine Vulvitis plasmacellularis ist beschrieben sowie der Befall nahezu aller weiteren Schleimhäute.
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Yun JSW, Veysey E. Plasma Cell Vulvitis: A Systematic Review of Interventions. J Low Genit Tract Dis 2021; 25:243-54. [PMID: 34086619 DOI: 10.1097/LGT.0000000000000609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Plasma cell vulvitis (PCV) is a rare chronic inflammatory disorder, where the symptoms can be severe and may affect patient's quality of life. However, there are currently no evidence-based treatment guidelines. The aims of this systematic review were to evaluate efficacy of individual treatments and to inform future research. MATERIALS AND METHODS A systematic search was conducted of publication between 1952 and August 2020 via MEDLINE, Embase, and Emcare. All publications that evaluated the efficacy of treatments for patients with PCV were included. Forty-seven publications comprising 45 case reports and case series and 2 cohort studies were included. RESULTS To date, there are no randomized controlled trials evaluating the efficacy of different treatment options. There are also no studies that assess the impact of treatment on quality of life. Topical corticosteroids are the most frequently used first-line therapy, with limited evidence to support their efficacy, followed by topical imiquimod and surgical excision. The least supported intervention is cryotherapy. CONCLUSIONS Although descriptive studies support the use of topical corticosteroids and, to a lesser degree, topical calcineurin inhibitors and imiquimod, this review highlights the need for standardized outcome measures and randomized clinical trials for more definitive therapeutic recommendations for women with PCV.
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Abstract
Diagnosis of genital inflammatory disorders may be difficult for several reasons, such as their similar appearance, possible misdiagnosis with infectious and malignant conditions, and peculiar anatomic conditions that may lead to modification of clinical features. Dermoscopy could be included as a part of the clinical inspection of genital diseases to support diagnosis, as well as to ideally avoid unnecessary invasive investigation. Practical guidance for the use of dermoscopy in the assessment of the main inflammatory genital diseases is provided, namely for lichen sclerosus, lichen planus, psoriasis, lichen simplex chronicus, and plasma cell mucositis.
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Affiliation(s)
- Alessandro Borghi
- Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Via L. Ariosto 35, Ferrara 44121, Italy.
| | - Annarosa Virgili
- Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Via L. Ariosto 35, Ferrara 44121, Italy
| | - Monica Corazza
- Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Via L. Ariosto 35, Ferrara 44121, Italy
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Fortier E, Cerruti A, Clec’h CLE, Bigot P. Review of cutaneous penile lesions. Journal of Clinical Urology 2018. [DOI: 10.1177/2051415817735232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Penile lesions often go undiagnosed and are difficult to identify for general practitioners and specialists, yet the stakes could be high. Indeed, the condition is highly varied and includes physiological variants, specific skin entities, genital dermatoses, genital ulcers, balanitis, premalignant lesions, and, finally, cancerous lesions. Knowledge of these entities can help to prevent overlooking potentially progressive lesions and diagnose cancerous lesions early so that patients can be offered conservative treatment, improving chances of survival. We review here these different lesions. Materials and methods and authors personal experience: A literature review was carried out in December 2016 using the Medline/Pubmed database, without any restrictions regarding the time period but limiting the review to studies in English or French. The main keywords used were “penile lesion”, “penile cancer”, “balanitis” and “premalignant lesion”. A specific review was performed for each type. All the pictures and cases came from our personal practice in our specific uro-dermatological consultation. All the patients gave us their informed consent for the utilization of their pictures. Results: We studied 66 references covering the field of benign and malignant lesions and their respective treatment. It is essential to take a medical history and perform a clinical examination, despite the fact that some lesions are not specific. A biopsy must be performed systematically in the case of all suspicious lesions. Conclusion: Lesions on genital organs in men are very diverse. Some are difficult to diagnose and treat, with the main challenge being early diagnosis of lesions with a high progressive potential in order to prevent dissemination and the need for mutilating surgery.
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Affiliation(s)
| | - Arnaud Cerruti
- Department of Urology, Angers University Hospital, France
| | | | - Pierre Bigot
- Department of Urology, Angers University Hospital, France
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Kumar B. Circumcision is still the gold standard in management of plasma cell balanitis. Dermatol Ther 2018; 31:e12661. [PMID: 30246920 DOI: 10.1111/dth.12661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 05/30/2018] [Accepted: 06/21/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Bhushan Kumar
- Shalby Multi-Specialty Hospital, Mohali, Punjab, India
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Corazza M, Toni G, Virgili A, Borghi A. Plasma cell vulvitis: further confirmation of the diagnostic utility of dermoscopy. Int J Dermatol 2018; 57:e164-e165. [DOI: 10.1111/ijd.14233] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/29/2018] [Accepted: 08/22/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Monica Corazza
- Dipartimento di Scienze Mediche; Sezione di Dermatologia e Malattie Infettive; Università degli Studi di Ferrara; Ferrara Italy
| | - Giulia Toni
- Dipartimento di Scienze Mediche; Sezione di Dermatologia e Malattie Infettive; Università degli Studi di Ferrara; Ferrara Italy
| | - Annarosa Virgili
- Dipartimento di Scienze Mediche; Sezione di Dermatologia e Malattie Infettive; Università degli Studi di Ferrara; Ferrara Italy
| | - Alessandro Borghi
- Dipartimento di Scienze Mediche; Sezione di Dermatologia e Malattie Infettive; Università degli Studi di Ferrara; Ferrara Italy
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Abstract
Zoon vulvitis or vulvitis chronica plasmacellularis is a rare, chronic benign
inflammation of the vulvar mucosa, diagnosed histologically, with variable
therapeutic responses. It is important to be diagnosed because it mimics the
presentation of other genital conditions, such as lichen planus and squamous
cell carcinoma, which require specific treatment. We report a case of a female
patient with three asymptomatic shallow ulcers on the labia minora. Laboratory
tests ruled out infectious diseases and the biopsy was consistent with Zoon
Vulvitis.
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Affiliation(s)
- Leandro Damiani
- Dermatology Service of Santa Casa de Misericórdia Porto Alegre - Porto Alegre (RS), Brazil
| | - Maurício de Quadros
- Dermatology Service of Santa Casa de Misericórdia Porto Alegre - Porto Alegre (RS), Brazil
| | - Váruna Posser
- Dermatology Service of Santa Casa de Misericórdia Porto Alegre - Porto Alegre (RS), Brazil
| | - Renan Minotto
- Dermatology Service of Santa Casa de Misericórdia Porto Alegre - Porto Alegre (RS), Brazil
| | - Ana Letícia Boff
- Dermatology Service of Santa Casa de Misericórdia Porto Alegre - Porto Alegre (RS), Brazil
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Abstract
Vulvovaginal conditions are common in mature women. This reflects age-related changes in immunity and skin barrier function of vulvovaginal tissues. Vaginal atrophy is commonly complicated by dryness and inflammation, which makes postmenopausal atrophic vaginitis a virtually ubiquitous condition. The differential of vaginitis includes inflammatory, infectious, and malignant diseases, plus drug hypersensitivity. Atrophic vaginitis is treated with estrogen replacement therapy. Vulvovaginal malignant melanoma occurs predominantly in postmenopausal women and carries a poor prognosis. Similarly, the incidence of vulvovaginal malignancies, such as squamous cell carcinoma and extramammary Paget disease, rises exponentially after 65 years of age. Early diagnosis of these malignancies is of utmost importance. Lichen sclerosus et atrophicus and vulvovaginal candidosis are among the most common postmenopausal vulvovaginal conditions. Lichen sclerosus et atrophicus is associated with significant morbidity, and its management can be challenging. The incidence of vulvovaginal candidosis increases in patients on estrogen replacement therapy.
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Affiliation(s)
- Natalie Matthews
- Department of Dermatology, Alpert Medical School of Brown University, Providence, RI
| | - Vivian Wong
- Department of Dermatology, Alpert Medical School of Brown University, Providence, RI
| | | | - George Kroumpouzos
- Department of Dermatology, Alpert Medical School of Brown University, Providence, RI; Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil.
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Bari O, Cohen PR. Successful Management of Zoon's Balanitis with Topical Mupirocin Ointment: A Case Report and Literature Review of Mupirocin-Responsive Balanitis Circumscripta Plasmacelluaris. Dermatol Ther (Heidelb) 2017; 7:203-210. [PMID: 28382428 PMCID: PMC5453920 DOI: 10.1007/s13555-017-0178-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Zoon's balanitis, also referred to as balanitis circumscripta plasmacellularis (BCP), is an idiopathic, benign inflammatory condition of the glans penis and foreskin most often seen in elderly uncircumcised men. A patient with a biopsy-confirmed diagnosis of BCP who was successfully treated with topical mupirocin ointment is described. METHODS The PubMed database was searched with the key words: bactroban, balanitis, cell, circumscripta, mupirocin, plasma, plasmacellularis, tacrolimus, Zoon. The papers generated by the search and their references were reviewed. RESULTS Treatments for BCP have previously included circumcision and topical calcineurin inhibitors. Our patient with BCP rapidly resolved after initiating treatment with mupirocin 2% ointment. CONCLUSION BCP is a benign dermatosis affecting the glans penis and foreskin. We confirm an earlier observation demonstrating successful management of this condition with topical mupirocin 2% ointment. Previously reported therapies include circumcision, topical calcineurin inhibitors, phototherapy, and laser therapy. However, based on our observations, topical mupirocin 2% ointment therapy may be considered for the initial management of patients with suspected BCP. Prompt response to mupirocin 2% ointment is highly suggestive of the diagnosis of BCP since morphologically similar skin conditions do not respond to this treatment.
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Affiliation(s)
- Omar Bari
- School of Medicine, University of California San Diego, La Jolla, CA, USA.
| | - Philip R Cohen
- Department of Dermatology, University of California San Diego, La Jolla, CA, USA.
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Abstract
Balanitis is a descriptive diagnosis for a heterogeneous group of infectious or inflammatory dermatoses which have to be differentiated from malignant conditions. Balanitis is caused not only by Candida spp. and bacterial infections, including anaerobic bacteria: viral infections, parasites and other sexually transmitted infections (STI) also have to be considered. Lichen planus, psoriasis and contact dermatitis can characteristically lead to inflammatory conditions of the glans penis. In addition to a complete skin examination, a thorough patient history with respect to topically applied products and sexual behavior is essential. Infections must be treated and the glans penis should be kept dry. It is important to ensure a balanced genital hygiene in patients. As a last resort therapeutic circumcision can be considered for most forms of chronic balanitis.
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Affiliation(s)
- S Borelli
- Dermatologisches Ambulatorium, Stadtspital Triemli Zürich, Herman-Greulich-Str. 70, 8004, Zürich, Schweiz,
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Borgia F, Vaccaro M, Foti A, Giuffrida R, Cannavò SP. Zoon's balanitis successfully treated with photodynamic therapy: Case report and literature review. Photodiagnosis Photodyn Ther 2016; 13:347-9. [PMID: 26321748 DOI: 10.1016/j.pdpdt.2015.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 08/24/2015] [Indexed: 11/22/2022]
Abstract
Zoon's balanitis (ZB) is an idiopathic chronic condition usually presenting as a solitary erythematous plaque on the glans of primarily uncircumcised, middle-aged to older men. The different treatment options for this condition often achieve partial results, with frequent recurrence after treatment withdrawal. Recently, photodynamic therapy (PDT) has been proposed as therapeutic option with discordant results. We treated a thirty-five year-old man affected by Zoon's balanitis, resistant to conventional treatments, with 3 sessions of topical ALA-PDT at two weeks intervals. At the end of the treatment period notable improvement of clinical features was observed, with almost complete clearance at 3 months' follow-up, high safety profile and absence of durable side-effects.
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Virgili A, Corazza M, Minghetti S, Borghi A. Symptoms in Plasma Cell Vulvitis: First Observational Cohort Study on Type, Frequency and Severity. Dermatology 2015; 230:113-8. [DOI: 10.1159/000367786] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 08/19/2014] [Indexed: 11/19/2022] Open
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