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