PLASMA CELL MUCOSITIS

By Gary M. White, MD


Plasma cell mucositis is caused by a dermal infiltrate rich in plasma cells. It is classically seen on the penis, called plasma cell balanitis (Zoon's balanitis), but a similar process may occur on the vulva, oral mucosa, and perianally.

Clinical

A shiny, red, erythematous, macule or plaque occasionally eroded and often with pinpoint red spots is characteristic. A biopsy is usually necessary to exclude malignancy and verify the diagnosis.

Plasma Cell Vulvitis

Burning and dyspareunia are common symptoms. Clinically, one sees chronic, well-circumscribed glistening, glazed, single or multiple erythematous patches with a faint orange hue. Any of the moist mucosal surfaces may be affected with the introitus the most common. Multiple pinpoint brighter purpuric spots ("cayenne pepper spots") and erosive lesions also may occur [Dermatology 2015;230:113-118].

Plasma Cell Cheilitis

Plasma cell cheilitis presents as a flat to raised, erythematous plaque with a dry, atrophic, shiny surface and varying degrees of fissuring on the lower lip of an elderly person. Hemorrhagic crusting rarely occurs.

Treatment

For lesions on the penis, see Zoon's balanitis. A medium to high-potency topical steroid topically or triamcinolone intralesionally may be tried. Other therapies include topical CSA, tacrolimus, imiquimod, and even surgery.

Plasma Cell Vulvitis

Topical steroids and topical calcineurin inhibitors are commonly used.

Plasma Cell Cheilitis

A medium to high-potency topical steroid ointment or tacrolimus is usually given.

References

Dermatology 2015;230:113-118

Vulvitis circumscripta plasmacellularis in the setting of lichen sclerosus. From JAAD July 2010 Volume 63, Issue 1, Pages e11–e13

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