Bowenoid Papulosis

Bowenoid Papulosis Definition

It is a pre-cancerous condition of the skin. Its presence is characterized by the development of several verrucous papules over the body of the penis. The papules are considered by experts to be in a transitional state between genital warts and Bowen disease.

The condition is found to develop in both males and females who are sexually active.

Bowenoid Papulosis History

The term ‘Bowenoid Papulosis’ was first invented in 1977 and described by Bart and Kopf. The disease had been named after the dermatologist John Templeton Bowen.

Bowenoid Papulosis Causes

Bowenoid papulosis occurs due to:

Induction of Human Papillovirus (HPV)

Bowenoid papulosis occurring in the genital area is caused by the human papillomavirus type 16. Sexually active individuals have higher risk of developing this condition because since the virus is sexually transmitted.

Excess exposure to sun rays

However, this disease usually results from excess exposure to the sun. People with fair skin are at risk of developing this disease. An individual is at higher risk of developing the condition in a particular skin region if he or she has had radiotherapy in the area. Exposure to arsenic can also lead to Bowenoid papulosis.

Weak immunity

A weak immune system is also responsible for contraction of this disease.

Other causes of this disease are:

• Verrucae
• Anogenital cancer
• Condyloma
• Anal intraepithelial neoplasia

Women, who have partners suffering from Bowenoid papulosis, are at higher risk of developing cervical cancer.

Bowenoid Papulosis Symptoms

The condition can affect any region of the skin. However, it is especially more common on the trunks, arms and legs. The disease manifests itself in the form of small lesions, appearing on the shaft of the penis in males or on the labia of females. The lesions appear as small red, flesh colored or brown warty lesions. These lesions may also be found on other portions of the genitals and in the region around the anus. These papules might get painful, itchy and inflamed.

These abnormal structures last for about 5 years in older patients and might never go away. They range from a few millimeters to several centimeters in size. The growths may also be noticed in the oral cavity and lower abdomen. A young pregnant woman may find the lesions automatically resolving after delivery. However, the growths would require immediate treatment if they persist, start bleeding or form a scab. Otherwise, an affected woman might develop skin cancer.

Bowenoid Papulosis Diagnosis

This disease is diagnosed by its appearance with the help of skin biopsy or dermoscopy. During laboratory analysis, application of white vinegar on them makes the subclinical lesions visible within 5 to 10 minutes. Histopathology test shows a network of irregular nuclei arranged that looks windblown. Some of the nuclei may be large, pleomorphic and hyper chromatic.

Bowenoid Papulosis Differential Diagnosis

The condition needs to be differentiated from other disorders that produce similar symptoms. These include:

• Lichen planus
• Squamous cell carcinoma
• Anogenital Bowen’s disease
• Seborrheic keratosis
• Basal cell carcinoma

In some cases, multinucleated keratinocytes and dyskeratosis atypical mitosis are also present along with this condition. The symptoms of these conditions need to be taken into account as well while making a proper diagnosis.

Bowenoid Papulosis Treatment

There are various treatment options for this disease. However, the type of treatment would be based on the size and thickness of the patches as also the number of them arising in an individual.

The following curative options need to be considered:

Cutterage and cautery

The affected skin portion, under the effects of local anesthesia, is scraped away. Heat and electricity is used to block bleeding and the region is left to dry and heal after a few weeks.

Imiquimod cream/chemotherapy cream (5-fluoroouracil)

The cream is applied to the affected area for a period of time. This leads to a temporary inflammation and reddening of the affected skin patch, following which the region gets cured.

Photodynamic therapy

The method involves application of a cream on the affected portion which is sensitive to light. After around 4-5 hours, the skin is subjected to laser treatment which destroys the abnormal cells underlying the lesions. The entire process takes about 20 to 45 minutes. A cloth is put over the affected area to protect the region from the light.

Cryotherapy

In this method, liquid nitrogen is sprayed onto the affected area to freeze the cells. The process is painful and the treated region might develop blisters and eject secretions. Later however, the patch dries and falls off within a few weeks after removal of the affected skin.

Surgery

Surgery involves cutting out the affected portion of the skin followed by stitching. However, this may not be a feasible option if there are many patches or if the patch is too large.

Bowenoid Papulosis may show a recurrence after every 3 to 6 months. Thus, follow-up treatment is required to make sure lesions do not appear or turn fatal.

Bowenoid Papulosis Complications

Sufferers of this condition have a high risk of developing various health complications, such as:

• Vulvar neoplasia
• Invasive squamous cell cancer
• Cervical neoplasia

Bowenoid Papulosis Prognosis

Young patients might require treatment for short period which could last for a few months. However, in case of old patients and those with immune deficiency, the condition might last for years. Generally, treatment proves successful. If left undiagnosed or untreated, the disorder can lead to squamous cell cancer in most patients.

Bowenoid Papulosis Pictures

Here are a few images of this skin disease.

Picture 1 – Bowenoid Papulosis

Picture 2 – Bowenoid Papulosis on Penis