Zoon's vulvitis - query bank

Question: A 59 year old presents with acute vulval inflammation. Histology - Zoon's vulvitis. Is this best managed by topical potent steroids?

Please note: the search for this response was carried out over 1 year ago. Eligible users may request an update of the evidence by submitting a new Clinical Query here.

Answer: Two cases of Zoon’s vulvitis successfully treated with topical steroids have been reported. (Botros, Neri). Another case showed only mild clinical and symptomatic improvement with topical corticosteroid treatment (Neri)

Other cases have been successfully treated with imiquimod, (Bhaumik, Ee, Frega) or interferon alpha (Morioka).

No trials that compared treatments for Zoon’s vulvitis were identified.
(Evidence level III)


  • Bhaumik J. Vulvitis circumscripta plasmacellularis: success with a modified treatment regimen using imiquimod. Journal of Obstetrics & Gynaecology. 26(1):72, 2006 Jan.
  • Botros SM. Dieterich M. Sand PK. Goldberg RP. Successful treatment of Zoon's vulvitis with high potency topical steroid. International Urogynecology Journal. 17(2):178-9, 2006 Feb. Abstract
  • Ee HL. Yosipovitch G. Chan R. Ong BH. Resolution of vulvitis circumscripta plasmacellularis with topical imiquimod: two case reports. British Journal of Dermatology. 149(3):638-41, 2003 Sep. Abstract
  • Frega A. Rech F. French D. Imiquimod treatment of vulvitis circumscripta plasmacellularis. International Journal of Gynaecology & Obstetrics. 95(2):161-2, 2006 Nov.
  • Morioka S. Nakajima S. Yaguchi H. Naito K. Iwahara K. Ogawa H. Vulvitis circumscripta plasmacellularis treated successfully with interferon alpha. Journal of the American Academy of Dermatology. 19(5 Pt 2):947-50, 1988 Nov. Abstract
  • Neri I. Patrizi A. Marzaduri S. Marini R. Negosanti M. Vulvitis plasmacellularis: two new cases. Genitourinary Medicine. 71(5):311-3, 1995 Oct. Abstract

Search date: September 2009

Classification of evidence levels

Ia Evidence obtained from meta-analysis of randomised controlled trials.

Ib Evidence obtained from at least one randomised controlled trial.

IIa Evidence obtained from at least one well-designed controlled study without randomisation.

IIb Evidence obtained from at least one other type of well-designed quasi-experimental study.

III Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies and case studies.

IV Evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities.

This clinical query answer was produced following the clinical query protocol as described here.

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Date published: 24/09/2009

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