Zoon´s Vulvitis: A Rare Differential Diagnosis of Vulvar Pruritus

Zoon´s vulvitis, also known as plasma cell vulvitis (PCV) is a rare inflammatory disorder of the female genital tract, which typically affects the vulva.Its real prevalence is supposed to be underreported as typical symptoms can mimic and be misdiagnosed as other more common vulvovaginal disorders.It usually presents as a well-circumscribed and erythematous patch/macule that can cause itching, burning, dysuria and dyspareunia.Histologically, it is characterized by a thinned epithelium with infiltration of more than 50% of polyclonal plasma cells in the underlying dermis.Here we present a 73-year-old patient referred to a gynecology consultation due to complaints of persistent vulvar itching and discomfort for the past 6 months.She was initially treated with topical antifungal and a course of corticosteroid therapy with persistence of complaints.On examination, she had an ecchymotic macule on the anterior one-third of the transition between the left labia minora and the labia majora.This lesion was biopsied and a Zoon´s vulvitis diagnosis was confirmed.Currently, she maintains topical estrogen therapy and regimens of topical corticosteroids when the condition worsens.Vulvovaginal erythema and/or pruritus may be caused by a range of conditions that varies from infectious, immunological, or even malignant causes.In cases of resistance to treatment or persistence of lesions it is therefore essential to perform a biopsy in order to avoid delays in instituting therapy and potential long-term complications.Although rare, this condition can cause serious discomfort to patients; therefore, more research is needed to establish its most cost-effective management.