Plasma cell balanitis/vulvitis
What is plasma cell balanitis/vulvitis?
Plasma cell disorders usually present as persistent, well-defined irritable red patches on the genitals. It is called plasma cell balanitis in men and plasma cell vulvitis in women because of the numerous plasma cells seen on skin biopsy. A plasma cell is a type of white blood cell found in some inflammatory conditions.
- Plasma cell balanitis affects the head of the penis (the glans) and is also known as balanitis circumscripta plasmacellularis and Zoon balanitis.
- Plasma cell vulvitis is most commonly found on the inside of the vulva at the entrance to the vagina (vestibule). It is also known as vulvitis circumscripta plasmacellularis.
What are the signs and symptoms of plasma cell balanitis/vulvitis?
In males, plasma cell balanitis is usually a single glistening orange-red plaque. In women there are usually several patches. Patients may have no symptoms but they may complain of tenderness and/or slight itchiness.
What causes plasma cell balanitis/vulvitis?
The cause of plasma cell balanitis/vulvitis is not known. The finding of plasma cells in a skin biopsy may be quite non-specific and may be a reactive response to an infection, irritation or injury. Several cases diagnosed originally as plasma cell balanitis/vulvitis turn out later to be other skin diseases such as an infection, allergic contact dermatitis, psoriasis, lichen planus or penile or vulvar intraepithelial neoplasia.
Diagnosis of plasma cell balanitis/vulvitis
Plasma cell balanitis/vulvitis can look similar to other skin conditions affecting the penis or the vulva. Characteristic histopathological features on skin biopsy of the area may be recommended by the dermatologist to help make the diagnosis and plan treatment.
Management of plasma cell balanitis/vulvitis
Topical steroid cream can be useful in some cases. This is applied as a thin smear on the patch for a few days. Treatment is repeated as necessary and may be required on several days each week. Other treatments reported to be of benefit in some cases include:
- Topical antibiotics
- Topical antifungal agents
- Topical calcineurin inhibitors such as tacrolimus ointment or pimecrolimus cream
- Imiquimod cream
- Surgical excision, electrosurgery or laser destruction. Circumcision is recommended for plasma cell balanitis and may result in cure.