Morbus Zoon - Dermatologische Aandoeningen en Behandeling

CLINICAL FEATURE

Symptoms

It is usually asymptomatic and patient only presents with change in appearance of the genitalia. However, sometimes, it might be accompanied with symptoms such as pruritus, dysuria, pain, and burning sensation. Rarely blood-stained discharge or dyspareunia has been described.[17]

Clinical appearance

(a and b) Well-circumscribed orange-red, shiny plaque on the glans penis and undersurface of the prepuce with multiple pinpoint red spots

Orange-red shiny plaque on the glans penis and undersurface of the prepuce

Table 1

Clinical criteria for diagnosing Zoon balanitis[18]

Sites affected

It is most commonly located on the glans penis, but inner surface of prepuce and coronal sulcus may be involved.[1] Female genitalia, especially labia minora, may be affected by similar lesions. Other sites are oral mucosa (gingiva, hard palate, buccal mucosa), conjunctiva, urethra, cheeks, and epiglottis.[13] It usually affects uncircumcised males, but only one case report of ZB affecting circumcised male in a HIV-positive patient had been described in the literature.[19]

Schuermann in 1960 proposed that these lesions at different sites were variants of the same pathologic process and suggested the term “plasmacytosis circumorificialis.”[20] Other authors supported their concept, but they gave their own name, for example, “plasmacytosis mucosae” and “plasma cell orificial mucositis.”[21]

Hoe ziet het er uit?

Omdat de afwijkende cellen zeer oppervlakkig gelegen is er (naast operatief verwijderen) nog een aantal andere behandelopties.

stikstof-therapie
een vries-behandeling met vloeibare stikstof is een snelle en vaak doeltreffende methode om de ziekte van Bowen op te ruimen.

5-fluorouracil creme (Efudix)
een behandeling met fluorouracil crème is vaak effectief. U moet dan zelf de creme gedurende een aantal weken (meestal 3 of 4) tweemaal daags aanbrengen.

fotodynamische therapie
fotodynamische therapie is ook geschikt om de ziekte van Bowen te behandelen. Bij deze behandeling worden de afwijkende cellen met een speciale crème gevoelig gemaakt voor zichtbaar licht.
Vervolgens vindt belichting plaats waardoor de cellen afsterven en de ziekte van Bowen wordt opgeruimd.

Wanneer er bij de arts enige twijfel bestaat of er mogelijk toch van een begin van huidkanker sprake kan zijn heeft het operatief weghalen de voorkeur.

Abstract

A 61-year-old female patient, phototype II, was referred to our department from her gynecologist with an asymptomatic lesion on the vulva, observed in her last routine visit, 3 months back. The patient denied having had prior pathologies or used any medications. Physical examination revealed three well-defined shallow ulcers on the labia minora, with a clean, red-orange base ( Figures 1 and ​ and2). 2 ). Laboratory tests ruled out infectious diseases. Biopsy revealed spongiotic changes and band-like infiltrate rich in plasma cells ( Figure 3 ). Based on the findings, the diagnosis of Zoon vulvitis was made. The patient was treated with hydrocortisone 2% cream and reviewed monthly, showing slow and gradual improvement of the lesions over the course of five months. Subsequently, the patient was monitored bimonthly and was advised to continue with annual gynecologic follow-up, remaining with no active lesions.

Ulcers with defined edges and margins and with a clean and red-orange colored base

Hematoxylin & eosin, X10 and X4: Spongiotic changes, bandlike infiltrate rich in plasma cells

StatPearls [Internet].

Kenia Lepe , Francisco J. Salazar .

Authors

Affiliations

Last Update: August 22, 2023 .

Identify characteristic symmetrical erythematous plaques with "cayenne pepper spots" on the prepuce or glans penis, indicative of balanitis circumscripta plasmacellularis.

Differentiate balanitis circumscripta plasmacellularis from sexually transmitted infections, drug reactions, other dermatoses, and neoplastic conditions such as erythroplasia of Queyrat.

Communicate effectively to convey the diagnosis, treatment rationale, and potential outcomes to patients, facilitating informed decision-making and adherence to management plans.

Collaborate with urologists, dermatologists, and other specialists when needed, ensuring comprehensive care and interdisciplinary insights for challenging cases.