Plasma Cell Balanitis Research Articles

Zoon's plasma cell balanitis associated with genital lichen planus.

Zoon's plasma cell balanitis associated with genital lichen planus.

A retrospective study of 129 patients with plasma cell balanitis

AbstractBackgroundPlasma cell balanitis (PCB) is a chronic inflammatory dermatosis of the glans penis and prepuce, typically presenting as discrete shiny bright red plaques. Research on PCB is scarce, with case reports and small series. The aetiology, incidence and prevalence of PCB remain unclear. Circumcision is considered as the treatment of choice. Topical treatments such as topical corticosteroids, calcineurin inhibitors, fucidic acid and imiquimod have been widely used, but they lack evidence of efficacy.ObjectivesThe objective of this study was to investigate the clinical profiles, treatment methods and outcomes of PCB patients in a relatively large cohort.MethodsWe concluded a retrospective study of 129 patients with the diagnosis of PCB between 1 January 2003 and 31 December 2018 at Tampere University Hospital (TAYS) dermatology department.ResultsThe majority of patients were treated with topical treatments only, while 31 patients (24%) eventually underwent circumcision. The most used and most effective topical treatments were tacrolimus (0.03% or 0.1%) and clobetasol propionate. Those treated with circumcision had a shorter follow‐up time (median 8 months vs. 47 months, p = 0.002) and were more likely to reach remission (46% vs. 16%, p = 0.002) compared with those treated with only topical treatments. Patients with more severe symptoms were more often treated with several topical treatments and to undergo circumcision, and they were more likely to ultimately reach remission. The follow‐up time was longer among patients with a histopathologic diagnosis than with a clinical diagnosis (median 16 months vs. 6 months, p = 0.01).ConclusionsTopical treatments are rarely curative, but among them tacrolimus and topical corticosteroids show the strongest evidence of efficacy. The rate of remission is significantly better among those circumcised, and it is to be considered already at an early stage. Further studies are needed to find the best care management for PCB.

Exploring reflectance confocal microscopy as a non-invasive diagnostic tool for genital lichen sclerosus.

The diagnosis of genital lichen sclerosus (LS) is often confirmed by obtaining a skin biopsy, which can lead to unwanted complications and is uncomfortable in the sensitive genital area. Thus, there is a need of finding novel, non-invasive techniques that can rapidly and accurately diagnose LS. The present study investigated the potential for reflectance confocal microscopy (RCM) to diagnose LS compared with healthy penile skin and other common penile skin disorders in males. A total of 30 male patients, including patients with LS, nonspecific balanoposthitis, plasma cell balanitis and psoriasis, and healthy individuals were included and were subject to non-invasive RCM investigation. Prominent fiber-like structures, representing hyaline sclerosis, were observed in the RCM images for almost half of the patients. Differences between healthy penile skin and LS were confirmed by identifying the edged papillae on healthy skin and their absence or obscureness in patients with LS. Notably, RCM could detect the atypical honeycomb pattern referring to dysplasia in 1 patient with LS with penile intraepithelial neoplasia. In conclusion, the present study demonstrated that RCM can detect sclerosis in penile LS. RCM can potentially become a valuable tool for monitoring patients with LS for dysplasia providing a useful non-invasive diagnostic tool for genital disorders.

開口部形質細胞症を考えた穿掘性陰部潰瘍の 1 例

開口部形質細胞症を考えた穿掘性陰部潰瘍の 1 例

Accuracy of dermoscopy in distinguishing erythroplasia of Queyrat from common forms of chronic balanitis: results from a multicentric observational study.

Clinical differentiation of erythroplasia of Queyrat (EQ) and chronic forms of balanitis may be challenging, especially in early phases or in overlapping cases. Dermoscopy has been shown to be a useful supportive tool in facilitating the distinction between tumoral and inflammatory skin conditions; yet, data on EQ and balanitis are scarce or sparse. To systematically assess the dermoscopic features of both EQ and common forms of chronic balanitis and to investigate the accuracy of dermoscopy in distinguishing these conditions. Subjects with EQ or chronic balanitis confirmed histologically or microbiologically (for infectious forms) were recruited. A representative dermoscopic image of a target lesion was retrospectively assessed for the presence of specific morphological findings. A correlation matrix was created using Spearman's rho. Proportions of dermoscopic variables scoring among different conditions were compared with the non-parametric Pearson's chi-square test. A total of 81 lesions (14 EQ, 23 psoriasis, 31 Zoon plasma cell balanitis and 13 candidal balanitis) from 81 patients were included in the study. Glomerular vessels (both clustered and diffusely distributed) were highly predictive for the diagnosis of EQ, while diffuse dotted vessels were strongly associated with psoriatic balanitis. Finally, Zoon plasma cell balanitis was characterized by orange structureless areas (focal or diffuse) and focused linear curved vessels, whereas cottage cheese-like structures (sparse white coating corresponding to Candida yeast colonies growth) showed a strong correlation with candidal balanitis. Erythroplasia of Queyrat and balanitis may display different dermoscopic patterns, thereby bearing theusefulness of dermoscopy as a supportive non-invasive tool for the recognition and differential diagnosis of such conditions.

A study of pattern of nonvenereal genital dermatoses of male attending skin OPD of tertiary centre in Kalaburagi

<p class="abstract"><strong>Background:</strong> Dermatoses involving genital areas are not always sexually transmitted. The diseases, which are not sexually transmitted, are referred as nonvenereal dermatoses. These disorders are the cause of considerable concern to patients causing mental distress and guilt feeling in them. Nonvenereal dermatoses are quiet often a diagnostic dilemma to the treating physician also. The aim was to determine clinical and epidemiological pattern of nonvenereal dermatoses of male external genitalia.</p><p class="abstract"><strong>Methods:</strong> This was a descriptive study of 50 consecutive male patients over age of 18 years, with genital lesions of nonvenereal origin, attending the skin outpatient department of BTGH, Kalaburagi. Study was done for a period of 6 months.<strong></strong></p><p class="abstract"><strong>Results:</strong> The study included 50 male patients with nonvenereal genital lesions. A total of 14 nonvenereal genital dermatoses were noted. The most common nonvenereal genital dermatoses were vitiligo (20%), fixed drug eruptions (16%), scabies (14%), pearly penile papule (10%), and dermatophytoses (10%). Other dermatoses included psoriasis, plasma cell balanitis or Zoon's balanitis, lichen simplex chronicus, lymphangioma circumscriptum, squamous cell carcinoma, scrotal dermatitis, lichen planus, steatocystoma multiplex and candidiasis.</p><strong>Conclusions:</strong>This study helps in understanding the etiological causes of nonvenereal genital dermatoses and their pattern in this region.<p> </p>

Plasma Cell (Zoon) Balanitis

Numerous IgG4 plasma cells and a high IgG4/IgG plasma cell ratio are important criteria in the diagnosis of IgG4-related sclerosing disease (IgG4-RSD), a steroid-responsive fibroinflammatory disorder. There is also a growing list of other inflammatory disorders that may mimic IgG4-RSD with many IgG4 plasma cells; however, limited data exist concerning whether plasma cell (Zoon) balanitis (PCB) is among these disorders. We, therefore, reviewed the clinical, histologic, and immunohistochemical features of PCB in 17 patients, including evaluation of CD3, CD20, CD138, κ, λ, IgG, IgG4, IgM, IgA, and IgD. All biopsies showed an infiltrate rich in plasma cells with variable numbers of B and T cells. IgG4 counts in the areas with the greatest density varied from 1/HPF to >200/HPF. Six of 17 (35.3%) cases demonstrated 50 or more IgG4 plasma cells/HPF, with an IgG4/IgG ratio of >40%, at least focally, in 2 of these cases. The plasma cells were clearly polytypic in 12/15 evaluable cases, with an increased proportion of κ-positive plasma cells in 3 (≥4 to 5:1). None of the patients had other clinical evidence of IgG4-RSD or a lymphoproliferative disorder. In conclusion, this study demonstrates that PCB should be added to the growing list of inflammatory disorders that can have significantly increased IgG4 plasma cells but which do not represent IgG4-RSD and which can have increased κ-positive plasma cells in the absence of malignant lymphoma.

A study of pattern of nonvenereal genital dermatoses of male attending skin OPD at a tertiary care center.

Nonvenereal dermatoses tend to create confusion from venereal dermatoses. This may be responsible for considerable concern to the patient as well as may cause diagnostic dilemma to the physicians. Nonvenereal dermatoses may not be restricted to genitalia alone; it may affect skin and mucous membrane also. Most of the patients with genital lesions had apprehension of suffering from some venereal disorders. The aim was to determine clinical and epidemiological pattern of nonvenereal dermatoses of male external genitalia. This was a descriptive study of 100 consecutive adult male patients with nonvenereal genital dermatoses attending skin and STD OPD at J A Group of Hospitals, Gwalior. Cases having any venereal dermatoses were excluded from this study. The study included 100 male patients with nonvenereal genital lesions. A total of sixteen nonvenereal genital dermatoses were noted. The most common nonvenereal genital dermatoses were vitiligo (18%), pearly penile papule (16%), fixed drug eruptions (12%), scabies (10%), scrotal dermatitis (9%) and lichen planus (9%). Other dermatoses included sebaceous cyst, psoriasis, lichen sclerosus, plasma cell balanitis or Zoon's balanitis, granuloma annulare, lichen nitidus, lymphangioma circumscriptum, papulo-necrotic tuberculid, squamous cell carcinoma and tinea infections. The age ranged from 18 years to 65 years with majority in the age group of 21-30 years (40%). This study highlights the importance of diagnosing common nonvenereal genital dermatoses. It also helps in avoiding the general misconception that all genital lesions are sexually transmitted.

Differentiation Between Balanitis and Carcinoma In Situ Using Reflectance Confocal Microscopy

Zoon plasma cell balanitis is a benign inflammatory disease of genital skin. It may be difficult to clinically distinguish between balanitis and carcinoma in situ (CIS); thus, a biopsy may be needed to exclude malignant disease. Reflectance confocal microscopy (RCM) is an in vivo imaging method to get morphologic information about architecture and single cells in the skin. To evaluate the ability of RCM to differentiate between balanitis and CIS compared with the gold standard histopathologic methods. Observer blinded study. A referral center. Fifteen patients with balanitis or CIS. Patients were assessed by clinical, histologic, and RCM findings. All lesions were imaged with the Vivascope 1500. In 5 cases of balanitis, the surrounding, noninvolved skin also was evaluated. Local recurrence, nodal metastasis, disease-specific death, overall death. The clinical diagnoses showed 9 cases of balanitis and 6 cases of CIS. With histopathologic analysis, 12 cases of balanitis and cases of CIS were diagnosed, and RCM evaluation confirmed these diagnoses. The most relevant RCM criteria for CIS were atypical honeycomb pattern, disarranged epidermal pattern, and round nucleated cells. Balanitis showed a nucleated honeycomb pattern and vermicular vessels. Scattered small bright cells and round vessels were present in all lesions. The adjacent normal skin showed a typical honeycomb pattern and round papillary vessels. We were able to differentiate between balanitis and CIS. Reflectance confocal microscopy may help to avoid biopsies at this sensitive site.

Plasma Cell Balanitis Presenting in a Patient with a History of Syphilis

Plasma cell balanitis (PCB), also knows as Zoon balanitis, is a benign asymptomatic but chronic and erosive inflammatory condition of the glans penis and prepuce that generally affects uncircumcised men in later years. Clinical presentation involves a single, shiny, well defined reddish patch. We describe the first case of PCB ever reported in a patient with a previous history of syphilis, and include a review of the current literature. A 57-year-old Hispanic man with a remote history of syphilis presented with a 6-month nonhealing, granulating ulcer of the foreskin and glans penis that had been repeatedly mistaken for syphilis and treated unsuccessfully with circumcision 3 weeks previously. Biopsy of the glans penis demonstrated sections with denuded chronic granulation tissue showing a fibrotic stroma with numerous blood vessels and a mixed inflammatory infiltrate including scattered plasma cells. It is important to differentiate PCB from a syphilitic chancre in a patient presenting with a nonhealing penile lesion. This case report demonstrates that these entities may be seen in the same patient at different times.

Balanite plasmocitária de Zoon: relato de dois casos tratados com pimecrolimo

Initially called (in French) "Balanoposthite chronique circonscrite benigne a plasmocytes", Zoon's plasma cell balanitis is a chronic inflammatory dermatosis affecting the glans and foreskin of uncircumcised men. The different treatment options for this condition often present partial results. Reports have shown therapeutic success using topical tacrolimus. We report the use of pimecrolimus, a homologue of tacrolimus, with good response. Two male patients diagnosed with Zoon's plasma cell balanitis, confirmed by biopsy, were subjected to daily treatment with topical pimecrolimus1%. Significant improvement was noted in patient 1 after 6 weeks and after 8 weeks in patient 2. Pimecrolimus cream may be an option for the treatment of this disease.

Successful treatment of plasma cell cheilitis with topical tacrolimus: Report of two cases

Plasma cell cheilitis is an uncommon chronic inflammatory dermatitis that presents with flat to slightly elevated erosive erythematous plaques. It is histologically characterized by plasma cell infiltrates into the mucosa. Other than the lip, genital areas are often involved, which is called plasma cell balanitis or vulvitis. Plasma cell cheilitis is sometimes resistant to conventional topical corticosteroid therapy. Other choices include oral griseofulvin, topical cyclosporine, and intralesional corticosteroid injection, all of which occasionally fail to produce satisfactory results. Recent reports show that topical calcineurin inhibitors are effective for plasma cell cheilitis, balanitis, and vulvitis. However, there are so far only 2 reports of plasma cell cheilitis successfully treated with topical pimecrolimus and tacrolimus. We present herein two cases of plasma cell cheilitis, in which topical tacrolimus showed beneficial effects, suggesting that this immunomodulatory agent is a promising option for plasma cell cheilitis.

Erythroplasia of Queyrat of the glans penis on a background of Zoon's plasma cell balanitis

Erythroplasia of Queyrat of the glans penis developed in a 79-year-old uncircumcised man on a background of biopsy proven Zoon's plasma cell balanitis affecting the same site on the glans. The Zoon's plasma cell balanitis had been treated with topical pimecrolimus for 1 month prior to the development of clinically evident erythroplasia of Queyrat. He was subsequently treated with topical 5-fluorouracil 5% for 2 weeks, which resulted in clinical clearance. He has since been circumcised.

Two cases of Zoon's balanitis treated with pimecrolimus 1% cream

Plasma cell balanitis is a disorder of the middle-aged and older uncircumcised male. Several treatments have been proposed to treat this disease, but plasma cell balanitis is often resistant to conventional therapy. We decided to evaluate the efficacy and tolerability of pimecrolimus 1% cream in resistant Zoon's balanitis. We report two cases of resistant Zoon's balanitis treated with topical pimecrolimus 1% cream. One of the two patients had a complete regression of the lesion after 2 months of therapy. The other one had a great improvement of the lesion, but a hyperpigmented patch persisted on the glans. Pimecrolimus 1% cream may be a valuable second-line treatment for patients with steroid related side effects or with steroid and other conventional therapy resistant Zoon's balanitis, as well as for those rejecting circumcision.

Full thickness squamous atypia of the glans penis on a background of Zoon's plasma cell balanitis

Erythroplasia of Queyrat (EQ) or squamous cell carcinoma in situ of the glans penis developed in a 79 year old uncircumsised gentleman who had a six year prior history of biopsy proven Zoon's plasma cell balanitis (ZB) affecting the same site on the glans. Prior to the development of clinically evident EQ, the glans had been treated with topical pimecrolimus 1% for one month. The glans was subsequently treated with topical 5‐flourouracil 5% for two weeks which resulted in clinical clearance.EQ is obviously an important differential for penile plaques because of the potential for progression to squamous cell carcinoma, while ZB is generally regarded as benign. The differentiation can only be reliably made histologically.There are other case reports of both EQ (1) and carcinoma of the penis (2) arising in patients with ZB, raising the question as to whether ZB may actually reflect a reaction to underlying pre‐existing pathology or even a premalignant state.The addition of topical pimecrolimus shortly before EQ became clinically evident in this patient is concerning in the light of recent concern regarding the carcinogenicity of topical calcineurin inhibitors (3).This case highlights the importance of close clinical follow up of persistent penile inflammatory lesions and prompt biopsy of clinically suspicious areas as second and potentially more serious pathology may occur concomitantly.

Plasma cell balanitis of zoon treated with topical tacrolimus 0.1%: report of three cases

Plasma cell balanitis of zoon treated with topical tacrolimus 0.1%: report of three cases

A focus on differential diagnosis of lichen planus and plasma cell balanitis

A focus on differential diagnosis of lichen planus and plasma cell balanitis

Plasma Cell Balanitis: Clinicopathologic Study of 112 Cases and Treatment Modalities

Plasma cell balanitis or Zoon's balanitis is an idiopathic benign condition of the genitalia that mostly presents as a solitary, persistent plaque on the glans primarily in uncircumcised, middle-aged to older men. One hundred twelve patients with a clinical diagnosis of plasma cell balanitis were studied between January 1985 and April 2003. The age of the patients ranged from 24 to 70 years. The majority of patients had symptoms for more than 12 months. Lesions involved the prepuce and glans in the majority of patients (66; 58.92%), the prepuce only in 26 patients (23.21%), and the glans only in 20 patients (17.85%). Tissue for histopathology was available in 96 patients. Histologically, epidermal edema, a dense upper dermal band of chronic inflammatory cells, including many plasma cells, dilated capillaries, extravasated red blood cells, and hemosiderin deposition, was seen. In most, cases, plasma cell balanitis was successfully treated by circumcision. This report describes our experience with plasma cell balanitis and reviews its clinical and histopathologic aspects. The treatment modalities are also reviewed, and the importance of circumcision as the treatment of choice is emphasized.

Non-Oncological and Non-Infectious Diseases of the Penis (Penile Lesions)

Skin diseases of the male genitalia can be categorized in three major areas: oncology, infectious and inflammatory diseases. Inflammatory dermatoses are frequently not restricted to the genital skin and often occur on other sites of the body. Herein we will deal the most important non-oncological and non-infectious skin disorders of the penis, such as psoriasis, lichen planus, lichen sclerosus, eczema, plasma cell balanitis, fixed drug eruption and vitiligo. Early adequate diagnosis is based on the principle of pattern recognition. Histological examination of a biopsy may help the clinician in the diagnostic process. The T cell is believed to play a central role in the pathogenesis of these inflammatory dermatoses, although the exact nature of the triggers involved in the T cell activation is not known. Anti-inflammatory therapy with topical corticosteroids is effective and safe. This is warranted since abnormalities of the penile skin are frequently accompanied by a profound psychological impact.

Plasma cell balanitis treated with tacrolimus 0.1%

Plasma cell balanitis or balanitis of Zoon (BZ) is a frequent diagnosis in mature men and lesions are generally localized on the glans but may involve the prepuce; its aetiology remains unknown. To present our experience with tacrolimus 0.1% ointment in the treatment of two patients with BZ refractive to other topical treatments. Two uncircumcised mature caucasian males were seen, both presenting with BZ; topical tacrolimus 0.1% ointment twice daily was prescribed in each case. Marked improvement of the lesions in both patients has been observed, with follow-up of 1 year and 10 months, respectively. Topical tacrolimus 0.1% ointment is an effective and safe treatment for BZ.