Plasma cell vulvitis: A rare vulvar dermatoses

A 49-year-old woman complained of a persistent reddish painful lesion over genitalia for the past 6 years associated with dyspareunia. There was no history of associated discharge or erosions/vesicles. Examination revealed a well-defined bright erythematous patch over the periurethral area [Figure 1a]. On palpation, the lesion was non-indurated and nontender. Histopathological examination showed spongiosis, lymphocytic exocytosis and band-like infiltrate comprising mainly of plasma cells with admixed lymphocytes and histiocytes. Several mildly dilated and congested capillaries were also seen [Figures 1b and 1c]. The patient was diagnosed as a case of plasma cell vulvitis. Topical mid-potency steroids were given once daily following which the lesion had significant improvement.

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Figure 1a:

Bright red erythematous shiny patch over periurethral area.

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Figure 1b:

Acanthosis and band-like dense infiltrate (H&E, 40×).

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Figure 1c:

Dense inflammatory infiltrate of plasma cells (H &E, 400×).

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Plasma cell vulvitis, also known as Zoon’s vulvitis, is an extremely rare vulval dermatoses presenting as solitary asymptomatic or pruritic sharply defined erythematous shiny plaque with ‘lacquer paint’ appearance. ¹ Common differentials include desquamative inflammatory vaginitis and erosive lichen planus. Desquamative inflammatory vaginitis presents clinically with white-yellow discharge and vaginal erythema in a confluent or petechial pattern along with the presence of papillary lymphocyte-predominant infiltrate. ² We wish to emphasise the classical presentation of a rare dermatoses through this case report and the need to differentiate it from other similar entities.