Tacrolimus 0.1% Ointment: Is It Really Effective in Plasma Cell Vulvitis?

Abstract

Background: Plasma cell vulvitis is a clinically and histologically well-characterized chronic disease that usually relapses after various topical therapies. Considering the inflammatory nature of the disease, the new topical calcineurin inhibitors have been also employed successfully in few cases of Zoon’s balanitis, the corresponding male condition. Objective: The aim of our study is to evaluate the effectiveness of tacrolimus ointment in a small group of plasma cell vulvitis sufferers. Methods: 4 women affected by biopsy-proved plasma cell vulvitis were enrolled, after informed consent. The topical drug was applied twice daily for 6 weeks, then tapered on the basis of the clinical results. Symptoms and objective parameters were obtained periodically at the beginning, after 6 weeks and up to the end of the topical treatment. A final biopsy was performed in 3 out of our 4 patients. The follow-up is still ongoing. Results: The comparative analysis of subjective, objective and histopathological data has shown discordant and less encouraging results than those reported for the corresponding male condition. Conclusion: At the moment, topical tacrolimus could be considered an alternative treatment for plasma cell vulvitis only in cases resistant to conventional therapies.

Plasma Cell Vulvitis: A Case Report and Review of Literature

“…However, there are cases of PCV with minimal plasma cells [9].Thus, it is important to know the other characteristics seen on biopsy. Other histologic features of PCV include 'lozenge shaped' (diamond shaped) keratinocytes, spongiosis with vascular dilatation, and hemosiderin deposition [2][3][4][5][6][7][10][11][12][13][14]. Though, one retrospective evaluation of PCV biopsy specimens reported that "lozenge-shaped" keratinocytes were rarely seen [9].…”

“…In a four patient case series evaluating the efficacy of PCV treatment with 0.1% tacrolimus, one patient reported complete resolution and another reported good resolution of symptoms [14]. The patient with complete resolution had to stop treatment after 16 weeks due to onset of pruritus and burning.…”

Plasma cell vulvitis: a review of two cases

“…It provides a diagnostic and therapeutic challenge, with large numbers of women receiving a delayed diagnosis and inappropriate treatments (3). The condition presents with pruritus, pain, dyspareunia and burning in the vulval area (3)(4)(5). Examination may reveal erythematous patches, erosive lesions, pinpoint petechial and purpuric spots (4,5).…”

“…The condition presents with pruritus, pain, dyspareunia and burning in the vulval area (3)(4)(5). Examination may reveal erythematous patches, erosive lesions, pinpoint petechial and purpuric spots (4,5). Histological features of the condition include the predominant feature of subepidermal plasma cell infiltrates in a band-like pattern, epidermal thinning which is thought to be a result of reduced size and quantity of keratinocytes and reduced size of the horny and granular cell layers.…”

“…Histological features of the condition include the predominant feature of subepidermal plasma cell infiltrates in a band-like pattern, epidermal thinning which is thought to be a result of reduced size and quantity of keratinocytes and reduced size of the horny and granular cell layers. Keratinocytes become diamond or lozenge shaped (5,6). Plasma cells usually predominate in the biopsies taken (5,6).…”