Balanitis plasmacellularis Zoon

Balanitis plasmacellularis circumscripta, zoon-balanitis, plasma cell balanitis (men); plasma cell vulvitis, plasma cell vulvitis (women).

Chronic benign, non-infectious genital mucosal inflammation with dense plasma cell infiltrate. Typical in uncircumcised men (glans, prepuce), more rarely vestibular in women.

Mostly occurs in men >40 years, often uncircumcised. Women less frequently affected, mean age 50-60 years.

Subdivision into male (zoon-balanitis) and female (plasma cell vulvitis) variant. No further subtypes.

Unclear. Chronic irritation favored by moisture, smegma, urine, lack of hygiene. Possible connection with lichen sclerosus, lichen planus or HPV. Hormonal and autoimmune factors also discussed in women.

Men: Reddish, sharply defined, smooth plaques with punctiform hemorrhages ("cayenne pepper spots"), usually asymptomatic. Women: Vestibular redness, burning, pruritus, dyspareunia. Chronic course.

Clinically with typical appearance, confirmed by biopsy: dense plasma cell infiltrate, extravascular erythrocytes, hemosiderin, epidermal atrophy. Dermatoscopy and confocal microscopy helpful. Biopsy essential to exclude neoplasia.

Men: Glans penis, inner foreskin. Women: Vestibule, introitus, labia minora, periurethral. Extragenital mucosa not typical.

Long-standing redness without response to antimycotics/corticoids. Men usually asymptomatic. Women more frequently report symptoms such as burning, itching and dyspareunia.

Dense, band-shaped plasma cell infiltrate, epidermal atrophy, spongiosis, hemosiderin, no dysplasia. Important: exclusion of a carcinoma in situ.

Recurrences frequent. Rare coexistence with dysplastic lesions or squamous cell carcinoma described. Therefore follow-up checks are necessary.

Benign, chronic course possible. Complete remission achievable with adequate therapy, especially after circumcision.

Good genital hygiene, daily cleaning, avoidance of irritation. Circumcision recommended in case of recurrent inflammation.

1. Edwards SK, Bunker CB, van der Snoek EM, et al. 2022 European guideline for the management of balanoposthitis. J Eur Acad Dermatol Venereol. 2023;37(6):1215-1228.
2. Relhan V, Kumar A, Kaur A. Zoon's Balanitis - Update of Clinical Spectrum and Management. Indian J Dermatol. 2024;69(1):63-73.
3. Sattler S, Elsensohn AN, Mauskar MM, Kraus CN. Plasma cell vulvitis: A systematic review. Int J Womens Dermatol. 2021;7(5 Pt B):756-762.
4. Bunker CB. Zoon balanitis - does it exist? J Eur Acad Dermatol Venereol. 2020;34(3):e116-e117.
5. Weyers W, Ende Y, Schalla W, Díaz-Cascajo C. Balanitis of Zoon: a clinicopathologic study of 45 cases. Am J Dermatopathol. 2002;24(5):459-467.
6. Lee MA, Cohen PR. Zoon balanitis revisited: balanitis circumscripta plasmacellularis resolving with topical mupirocin. J Drugs Dermatol. 2017;16(3):285-287.
7. Bari O, Cohen PR. Successful management of Zoon's balanitis with topical mupirocin: a case report and literature review. Dermatol Ther (Heidelberg). 2017;7(2):203-210.
8. Giorgio CMR, Briatico G, Licata G, et al. Topical cyclosporine 5% cream in Zoon's balanitis resistant to other therapies: a case report. Dermatol Ther. 2021;34(2):e14807.
9. Xiong X, Chen R, Zheng X, et al. Successful treatment of plasma cell balanitis associated with male genital lichen sclerosus using abrocitinib. JAAD Case Rep. 2024;46:85-88.
10. Lee A, Fischer G. Successful treatment of plasma cell vulvitis: a case series. JAAD Case Rep. 2022;19:84-88.