Bowenoid Papulosis

Bowenoid Papulosis

Article
Men's Health
Skin Care
+2
Contributed byLester Fahrner, MD+1 moreJun 10, 2022

What are the other Names for this Condition? (Also known as/Synonyms)

  • Multicentric Pigmented Bowen Disease
  • Multifocal Indolent Pigmented Penile Papules

What is Bowenoid Papulosis? (Definition/Background Information)

  • Bowenoid Papulosis is described as a ‘mostly’ benign condition affecting the skin of the genitalia. Its presence is manifested in the form of multiple small fleshy lesions; solitary lesions may be observed in some cases
  • Between 2-6% of Bowenoid Papulosis cases are associated with malignancy. Some studies inform that an invasive carcinoma can develop in approximately 2.5% of the patients
  • Bowenoid Papulosis is an uncommon skin condition; young adult males have a high risk for the same. A close association with human papilloma virus (HPV) infection is noted
  • The cause of Bowenoid Papulosis is unknown, but it is influenced by factors such as infection by HPV, poor immunity, high-risk sexual practices, etc.
  • The condition may be treated through surgery or laser surgery. The prognosis of Bowenoid Papulosis with early diagnosis and treatment is generally good

Who gets Bowenoid Papulosis? (Age and Sex Distribution)

  • Bowenoid Papulosis occurs predominantly in sexually-active adults; typically, in young males. Females are also affected, but to a much lesser extent
  • It is a rare condition, but the incidence of Bowenoid Papulosis is reported to be increasing
  • Individuals with congenital HIV infection may develop Bowenoid Papulosis at an early age
  • The condition has no specific geographical, racial, or ethnic preference; it is observed around the world

What are the Risk Factors for Bowenoid Papulosis? (Predisposing Factors)

The following factors increase the risk for Bowenoid Papulosis:

  • Infection with human papilloma virus (HPV); subtypes 16, 18, 33, 35, and 39 have been implicated
  • High-risk sexual behavior; sexual promiscuity
  • Weakened immune system as a result of HIV infection or AIDS, due to administration of immunosuppressants, or cancer chemotherapy

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Bowenoid Papulosis? (Etiology)

The exact cause of development of Bowenoid Papulosis is not completely known in a majority of cases.

  • In case HPV infection is associated with the condition, it may be caused by alteration in the DNA by the human papilloma virus that results in cell proliferation
  • A few DNA-based studies have indicated that squamous cell carcinoma in situ (low-grade) may manifest itself as Bowenoid Papulosis
  • The papules/plaques have shown gene mutations involving the TP53 gene; researchers believe that this factor may play an important role in the development of the tumor (oncogenesis)
  • Many researchers consider Bowenoid Papulosis to be an in-between stage to the common wart (verruca vulgaris) and squamous cell carcinoma in situ. The terminology representing this is high-grade squamous intraepithelial lesion (HSIL)

What are the Signs and Symptoms of Bowenoid Papulosis?

Bowenoid Papulosis signs and symptoms may include:

  • The presence of single or many/multifocal skin lesions on or around the genitals
  • The plaques/papules may be varied with respect to each other, but are normally small-sized, round, and isolated or grouped together
  • The size of the lesions may be between 2 to 20 mm
  • The outer skin on the lesions may be peeled-off and present a smoothened surface
  • The tumors may be brown or black; some are red or pink in color
  • Extremely rarely, the papules may be present outside the genitals  (extra-genital sites)
  • Typically, the lesions do not present any significant symptoms

How is Bowenoid Papulosis Diagnosed?

Some of the tests that may help in diagnosing Bowenoid Papulosis include:

  • Complete physical examination with detailed medical history evaluation
  • Examination by a dermatologist using a dermoscopy, a special device to examine the skin
  • Skin or tissue biopsy: A skin or tissue biopsy is performed and sent to a laboratory for a pathological examination, who examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. A biopsy is performed to rule out other similar conditions too

Note: Abnormal Pap smear test results may be reported in women who have sexual partners with Bowenoid Papulosis.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Bowenoid Papulosis?

The complications of Bowenoid Papulosis could include:

  • Cosmetic concerns in the individuals
  • Discomfort in having sex
  • Development of cancer: A malignant transformation is observed in approximately 1 in 40 individuals with Bowenoid Papulosis
  • Potential transmission of HPV to sexual partners

How is Bowenoid Papulosis Treated?

The treatment options for Bowenoid Papulosis may include:

  • Surgery: Complete surgical excision of the skin lesions can be curative
  • Laser ablation: The use of laser to remove solid tumors or lesions
  • A spontaneous regression of the skin lesions has been occasionally observed
  • Close monitor and follow-up examinations of the condition

How can Bowenoid Papulosis be Prevented?

Some of the following measures may help in the prevention of Bowenoid Papulosis:

  • Using condoms, avoiding multiple sexual partners, and taking other steps to avoid sexually-transmitted infections
  • Undertake immediate treatment of ulcers in the genital region
  • Avoidance of smoking
  • Availing vaccinations against the human papilloma virus (HPV)
  • Maintaining personal hygiene

What is the Prognosis of Bowenoid Papulosis? (Outcomes/Resolutions)

  • The prognosis of Bowenoid Papulosis can vary from one individual to another, but is generally excellent with early diagnosis and treatment, in a majority. In some individuals, the condition gets better on its own
  • Bowenoid Papulosis is typically a benign condition; an association of the skin condition with malignancy is infrequently noted. In such cases, the prognosis may be dependent upon early detection and appropriate treatment of the condition

Additional and Relevant Useful Information for Bowenoid Papulosis:

  • Squamous cell carcinoma in situ of penis is a malignant condition affecting the skin or mucosal membranes of the penis. It is also known as Bowen disease

The following link may help you find useful additional information on squamous cell carcinoma in situ of penis:

https://www.dovemed.com/diseases-conditions/squamous-cell-carcinoma-situ-penis/

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On the Article

Krish Tangella MD, MBA picture
Approved by

Krish Tangella MD, MBA

Pathology, Medical Editorial Board, DoveMed Team
Lester Fahrner, MD picture
Reviewed by

Lester Fahrner, MD

Chief Medical Officer, DoveMed Team

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