Unresponsive Zoon’s vulvitis and balanitis treated with topical pimecrolimus: our experience

Unresponsive Zoon’s vulvitis/balanitis treated with topical pimecrolimus: our experience Zoon’s vulvitis and balanitis are notorious for their recalcitrant nature to conservative topical and some surgical therapy, and frequently balanitis requires circumcision as a curative measure. Topical calcineurin inhibitors (tacrolimus and pimecrolimus) approved for atopic dermatitis, have a potential in other inflammatory skin diseases. We investigated the efficacy and safety of pimecrolimus 1% cream in Zoon’s vulvitis and balanitis unresponsive to conservative topical therapy with a follow-up period of 18 months. Eleven patients (four woman and seven uncircumcised men ) aged between 45 and 78 years with histologically proven Zoon’s vulvitis or balanitis, were treated for 16 weeks twice daily with pimecrolimus 1% cream in an observational study. Clinical examination and recording of patients symptoms was performed before, after four and eight weeks, and after three and four months of therapy, respectively. All cases had photographs taken before and after treatment. All patients experienced improvement in symptoms with remarkable relief of pruritus and burning after the first weeks of treatment. At the end of therapy, clinical resolution was observed in ten patients (four woman and six men). Partial resolution was reached in one man. All patients showed no relapse during the follow-up period. On the basis of our case observations, pimecrolimus seems to be effective in Zoon’s vulvitis and balanitis unresponsive to conservative topical therapy. We emphasize its possible use as an alternative therapy expecially in men who declines circumcision.