Bowenoid papulosis

Definition

Bowenoid papulosis is an uncommon sexually transmitted condition that occurs in both males and females. It is characterized by multiple well-demarcated red-brown to violaceous papules in the genital area.[1].

Epidemiology

• It was first described in 1977 by Kopf and Bart as penile papules.
• However, it occurs at both sexes.
• It tends to affect young sexually active people.

Cause

• BP is a sexually transmitted condition associated with HPV infection.
• Most lesions are associated with oncogenic HPV types mainly the HPV 16 genotype but occasionally HPV 18, 31, 33, 34, 35, 39, 42, 48, 51, 52, 53 and 54 are detected.[2].
• BP may also occur in immunocompromised individuals such as in organ transplant recipients.
• Smoking has recognition as a recurrence factor.

Signs and symptoms

• It is clinically characterized by multiple well-demarcated red-brown to violaceous papules, usually less than 1 cm in size. [3].
• The surface of the lesion can be flat, smooth, papillomatous or verrucous.
• Some papules may coalesce into large plaques.
• Sometimes, BP presents as warty white plaques.
• The distribution of lesions is commonly discrete; sometimes BP can have an annular or linear exhibition.
• In men, BP lesions primarily involve the penile shaft, but may also involve foreskin, glans, scrotum as well as the anus.
• Whereas in women, the lesions are usually bilateral and affect labia major, labia minor, clitoris, inside the vagina, inguinal folds, and perianal area.
• The lesions are generally darker in women than in men.
• They are usually asymptomatic; occasionally, patients may complain from pruritus and soreness of the affected area.
• Extragenital BP is a very rare condition, and it may involve the face, fingers or neck, with or without concomitant genital lesions.

Diagnosis

• The diagnosis is usually by a skin biopsy. [4].
• HPV subtyping may also be a recommended next step.
• Microscopic findings show typical a feature of Bowen’s disease with only a few differentiating features.
• The diagnosis of BP is based on clinical grounds and histopathological correlation.
• Furthermore, a skin biopsy is recommended in case of recalcitrant lesions to standards therapies to rule out malignancy.
• An extensional assessment of HPV infection is mandatory, including examination of the oral, genital, and anal area.
• Besides, anoscopy should be performed in the case of receptive anal sex.
• All this must be performed for the patient as well as the partner.

Treatment

• The treatment aims to prevent malignancy transformation and to preserve the normal tissue and function.
• Treatment modalities include locally ablative or destructive therapies such as carbon dioxide (CO2) laser vaporization, cryotherapy, electrocoagulation, 5-aminolevulinic acid-mediated photodynamic therapy (ALA-PDT), excisional surgery, and 5 fluorouracil (5FU).
• Moreover, topical imiquimod cream 5% once a day on an alternate day for one month has proven good results on limited lesions of BP with viral clearance in some cases.
• However, relapse often occurs with all treatment modalities.
• Furthermore, there are prophylactic vaccines to prevent infection with oncologic HPV subtypes.
• Moreover, prevention from recurrence correlates with cessation of cigarette smoking.[5].

Prognosis

Lesions may regress spontaneously or persist for several years with older persons or immunocompromised patients. It may rarely transform into Bowen’s disease or invasive squamous cell carcinoma.

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NIH genetic and rare disease info

• NIH info on Bowenoid papulosis

Bowenoid papulosis is a rare disease.

Bowenoid papulosis Resources
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