Successful treatment of plasma cell vulvitis: A case series

Plasma cell vulvitis: A case report

Plasma cell vulvitis (PCV) is a rare inflammatory condition characterised by plasma cell infiltration in the vulva. A woman in her 80s was referred to a specialist gynaecology clinic with chronic, painful vulval ulcers that were non-responsive to topical betamethasone. Following a biopsy confirming PCV, combination therapy was initiated. This included non-pharmacological management, such as promoting aeration and using hypoallergenic clothing and washes, combined with the daily application of clobetasone cream 0.05% and clindamycin cream 0.1%. Additionally, topical estriol 1% was applied twice weekly. The patient experienced rapid symptom resolution, with the PCV lesion healing within six weeks of starting treatment. This case documents the rare occurrence of plasma cell vulvitis presenting as chronic vulval ulceration, and proposes a treatment regimen worth considering in instances where monotherapy has been ineffective.

Plasma Cell Vulvitis: A Classification Into Two Clinical Phenotypes

OBJECTIVE

The etiology of plasma cell vulvitis (PCV) is debated. The authors aimed to test the hypothesis that PCV could be divided into 2 clinical phenotypes.

METHODS

Patients with a clinico-pathological diagnosis of PCV and with available vulvar photos seen in a vulvar clinic were retrospectively studied. The cases of PCV were divided into 2 groups: non-lichen-associated (primary PCV) and lichen-associated (secondary PCV). The 2 groups were compared in terms of age, menopausal status, location of the PCV, and 12 histologic parameters (Fisher exact test, p < .05).

RESULTS

Thirty-five patients (20 primary and 15 secondary PCV) were included. The 2 groups did not differ in terms of age (mean, 65; range, 50-85) or menopausal status. Primary PCV was located exclusively on the vestibule for 19/20 patients, whereas secondary PCV was extravestibular for 14 of 15 patients, either exclusively (2) or both extravestibular and vestibular (12). One patient with secondary PCV had solely vestibular involvement. Five histological features were observed significantly more often in case of secondary PCV: epidermal atrophy, parakeratosis, dermal and epidermal neutrophils, and dermal eosinophils.

CONCLUSIONS

Plasma cell vulvitis can be divided clinically into 2 phenotypes. Primary non-lichen-associated PCV is restricted to the vestibule and could be the vulvar counterpart of atrophic vaginitis. Secondary lichen-associated PCV is both extravestibular and vestibular, and its clinical and histological features should be looked for outside the PCV areas. This division of PCV into 2 clinical phenotypes could have therapeutic implications.

Complex vulvar and vaginal disease in menopause

PURPOSE OF REVIEW

Menopause is a time of vulvar and vaginal changes that are physiologic and are often symptomatic. These changes can impact up to 50% of women in menopause. There are also several vulvar dermatoses that are more common after menopause and should be recognized early to allow for symptomatic treatment. Some of these conditions can lead to squamous cell carcinoma over time, and early recognition and appropriate treatment reduce this risk. Treatment for women with symptomatic vulvar and vaginal conditions is important for maintaining the quality of life.

RECENT FINDINGS

There are multiple review articles, small case series, and small comparative trials, but definitive trials are unavailable for most of these conditions.

SUMMARY

Current research on pathophysiology and treatment is limited to all of these conditions, and more focus on these life-altering conditions is warranted.

Inflammatory Vulvar Dermatoses (Part I)

Vulvar disease is common, and urologists are often the first providers to see patients with a vulvar skin condition. Primary vulvar dermatoses can be localized to the anogenital area or a manifestation of more diffuse cutaneous disease. Additionally, secondary dermatoses can develop from exogenous agents and inflammatory vaginitis. Vulvar conditions are challenging to diagnose due to location and different types of skin and mucosal epithelium involved. Herein, we provide an overview of noninfectious inflammatory vulvar dermatoses (part I) and benign and malignant vulvar neoplasms (part II), grouped by morphologic findings. We include diagnostic evaluation, workup, and management of these conditions.