Discordant Results with Pimecrolimus 1% Cream in the Treatment of Plasma Cell Balanitis

Abstract

Plasma cell balanitis of Zoon is a chronic, benign, inflammatory dermatosis of the glans penis and prepuce. The exact aetiology is unknown. The treatments described to date have provided only partially successful results. Recently, several reports of plasma cell balanitis successfully treated with calcineurin inhibitors have been published. We report 3 cases of plasma cell balanitis refractory to several treatments with steroids and antifungals treated with pimecrolimus 1% cream applied twice daily: 1 patient had a complete resolution, 1 patient had a marked response but relapsed during the treatment and the last patient had a partial response due to the development of a side effect that precociously required to stop the treatment. One patient referred a slight pruritus after the first applications of the cream that spontaneously disappeared after a few minutes. Additional experiences are needed to determine if topical pimecrolimus is an effective and safe treatment for plasma cell balanitis.

Therapeutic Efficacy of Topical Calcineurin Inhibitors in Plasma Cell Balanitis: Case Series and Review of the Literature

“…However, these treatment options are often rejected by patients, since they are considered as quite aggressive. Therefore, several topical (or intralesional) therapies have been tried with various results, such as corticosteroids, antibacterial and antifungal agents, fusidic acid, trimovate, tacrolimus and pimecrolimus [3,4,5,6,7,8,9,10]. …”

“…Regarding treatment of PCBZ using 0.1% topical pimecrolimus twice daily, Bardazzi et al [3] reported 2 cases with complete remission or great improvement after 2 months, while Delgado et al [4] presented 2 cases with great improvement after 6-8 weeks of application. Moreover, Stinco et al [10] published 3 cases with partial to complete resolution of the lesions within a month. Unfortunately, the literature on PCV treated with topical calcineurin inhibitors is limited to 1 reference, where Virgili et al [11] reported their experience.…”

“…It has been suggested that tacrolimus may affect the plasma cell response via its action on helper T cells or a possible underlying T-cell dysfunction [5]; last, there is also the proposal that PCBZ may be a secondary phenomenon found in other inflammatory conditions that are responsive to tacrolimus treatment [5]. Regarding pimecrolimus, it is possible that it acts on the helper T cells and blocks the release of cytokines attracting the plasma cells, avoiding in this way their colonization of the dermis [10]; additionally, the inhibition of histamine release by mast cells is the probable mechanism of improvement of symptoms [10]. …”

“…Recently several reports of PCBZ and PCV treated with calcineurin inhibitors, tacrolimus and pimecrolimus, have been reported in the literature [3,4,5,6,7,8,9,10,11]. We present 9 cases of PCBZ treated with tacrolimus 0.1% ointment (Protopic, Toyama, Japan) and review the literature of PCBZ and PCV and their response to these topical immunomodulators.…”

Zoon balanitis: A comprehensive review

“…Furthermore, pimecrolimus leads to inhibition of histamine release by mast cells, which may result in improvement of the symptoms. [343536] TCI are being used in the management of several dermatological conditions, due to their efficacy, safety profile, lack of rebound effect, and absence of tachyphylaxis. Most of the researchers have used TCIs in ZB for 4–8 weeks resulting in significant clinical improvement without any severe side effect.…”