Plasma Cell Vulvitis
Plasma cell vulvitis is a rare condition of the introitus that most often affects postmenopausal women. It may be asymptomatic but more often causes pain, burning, and dyspareunia. It manifests as bright erythematous lesion on the medial vulva and is refr
- PDF / 348,192 Bytes
- 2 Pages / 504.567 x 720 pts Page_size
- 63 Downloads / 169 Views
26
Darion Rowan
26.1 Introduction Zoon first described glazed erythema of the glans penis in 1952. A female counterpart was recognized 3 years later. The histology showed a plasma cell-rich dermal infiltrate. Plasma cell vulvitis is a rare, benign condition of the introitus that most often affects postmenopausal women. It can develop in the presence of lichen sclerosus or other dermatoses of the vulva, and the course can be one of relapses and remissions. The cause is not known, but some consider it is a variant of lichen planus. Spontaneous remission may occur.
26.2, and 26.3). The lateral vulva is less commonly affected, and the anatomy is not altered (unless by concomitant lichen sclerosus or lichen planus).
26.3 Histopathology On histological examination, there is epidermal atrophy with an underlying dense inflammatory dermal infiltrate. The predominant cells are plasma cells: 50% or more is diagnostic of plasma cell vulvitis; if there are 25–50%, the diagnosis is likely. There are dilated capillaries and hemosiderin deposition which is the cause of the brown
26.2 Clinical Presentation The most common symptom is soreness but burning and pruritus may be experienced. It causes dyspareunia and often leads to apareunia because of severe pain experienced with intercourse. Dysuria, a pinky brown discharge, and bleeding on wiping are other symptoms. Some women are asymptomatic [1–5]. Examination findings are of shiny or glistening erythematous or orange macules with brown or purpuric spots affecting the medial labia minora, posterior fourchette, and periurethral mucosa. These changes are usually multifocal (Figs. 26.1, D. Rowan (*) Omnicare Women’s Health, Auckland, New Zealand
Fig. 26.1 Plasma cell vulvitis with patchy orange-red discoloration of the introitus and periurethral mucosa
© Springer International Publishing AG, part of Springer Nature 2019 J. Bornstein (ed.), Vulvar Disease, https://doi.org/10.1007/978-3-319-61621-6_26
211
D. Rowan
212
and pemphigus vulgaris; fixed drug eruption; and trauma.
26.5 Treatment
Fig. 26.2 Dark red-brown patches and macules localized to anterior introitus in plasma cell vulvitis
Treatment for plasma cell vulvitis is often not effective. Topical preparations which may be beneficial are corticosteroids, tacrolimus, misoprostol (compounded 0.1% in white soft p araffin), and imiquimod. Intralesional steroids and interferon have been used, as have systemic steroids, antibiotics, methotrexate, and retinoids. Laser ablation and surgical excision have sometimes been used.
Plasma Cell Vulvitis: Breaking the Myths
• When an erythematous lesion is present on the medial vulva and vestibule, do not consider only lichen planus—it may also be plasma cell vulvitis. • Histopathological examination reveals dense inflammatory dermal infiltrate. When 50% or more of the leucocytes are plasma cells, it is diagnostic of plasma cell vulvitis. • Although most texts preach for detailed examination and the importance of making a definite diagnosis of any vulvar lesion, treatment o
Data Loading...
