What is Bowenoid Papulosis?
Bowenoid papulosis is a rare disease most commonly transmitted through sexual contact. It was initially recognized in 1977 and was thought to only affect the penis, but it has since been observed in individuals of all genders. The disease usually impacts young and sexually active people.
Previously, this disease was named differently depending on its location — “vulvar intraepithelial neoplasia (VIN)” when it occurred on the vulva and “penile intraepithelial neoplasia (PIN)” when it was on the penis. It was also often confused with two related diseases, called Bowen’s disease and erythroplasia of Queyrat. But it’s now recommended to avoid using those terms for lesions in the genital and anal area.
Despite this, many skin experts still consider Bowenoid papulosis as a unique variant of these diseases. Bowenoid papulosis is caused by the human papillomavirus (HPV) and usually appears as a single or multiple skin-colored bumps in the genital and anal areas.
The disease can last anywhere between 2 weeks to several years. When looking at the disease clinically, it resembles genital warts. Yet, when studied under a microscope (histologically), it closely matches Bowen’s disease, a type of skin cancer known as squamous cell carcinoma in situ.
Generally, treatment is conservative, and Bowenoid papulosis lesions are often harmless. They usually disappear on their own without any lasting effects in persons with healthy immune systems. However, a small group of these lesions can potentially transform into a type of skin cancer called invasive squamous cell carcinoma.
What Causes Bowenoid Papulosis?
Bowenoid papulosis is a condition that is passed on through sexual contact and is linked to an infection caused by the Human Papillomavirus (HPV). The majority of the time, this problem is related to certain high-risk types of HPV, especially HPV 16, although occasionally it can also involve other types such as HPV 18, 31, 33, 34, 35, 39, 42, 48, 51, 52, 53, and 54.
Bowenoid papulosis can also appear in people with weakened immune systems, for instance, those who have had an organ transplant. Additionally, it has been seen that smoking may possibly lead to a recurrence of the condition.
Risk Factors and Frequency for Bowenoid Papulosis
Bowenoid papulosis, a skin condition, mainly affects people in their 30s to 50s who are sexually active, with the average age being 31 years. However, the condition can occur in anyone between 3 and 80 years old. While it can affect both genders, more recent cases have been found in women, with roughly 5 out of every 100,000 women affected. The exact number of people with bowenoid papulosis is not known because its symptoms are similar to genital warts. People of all races can get bowenoid papulosis.
- Bowenoid papulosis commonly occurs in sexually active people in their 30s to 50s, with an average age of 31.
- It can appear in any age range, from 3 to 80 years old.
- The condition affects both genders, but recent data show more women are affected.
- Estimations show that about 5 in every 100,000 women have it.
- The true number of cases is unknown as its symptoms are similar to genital warts.
- People of all races can get bowenoid papulosis.
Signs and Symptoms of Bowenoid Papulosis
Bowenoid papulosis is a rare condition, often found in sexually active individuals. Key identifiers for this disease are numerous small red-brown to violet lumps, usually less than 1 cm. These can look flat, smooth, have a warty-like appearance or look like they’re erupting. Sometimes these lumps can merge together to form larger patches. In some instances, Bowenoid papulosis appears as warty white patches.
The placement of these lumps can vary, with arrangements from spread out to lining up or forming a ring. Men with this condition often have affected areas on the penile shaft, but this can also spread to the foreskin, the head of the penis, the scrotum, and even the anus. In women, the lesions tend to affect both sides and can be found on the large and small lips of the vagina, the clitoris, inside the vagina, the thigh crease, and the area around the anus.
The affected areas tend to be darker in women than in men. Although usually painless, sometimes people might complain about an itchy or sore feeling in these areas. A super rare form of Bowenoid papulosis can affect the face, fingers, or neck, either with or without the genital lumps.
Testing for Bowenoid Papulosis
If your doctor suspects that you might have a skin condition called bowenoid papulosis, which has the potential to become cancerous, they might recommend a skin biopsy. The biopsy is a test where a small sample of your skin is taken and examined under a microscope. When the doctors look at this skin sample, they see certain features that are common with Bowens disease, another skin condition. But there are a few features that help tell these two conditions apart.
These features can include the patchy skin rash, the number of skin rashes, the patient’s age, and changes in specific skin cells. They also see more dilated (or enlarged) blood vessels in the skin. These clues help doctors confirm a diagnosis of bowenoid papulosis. In some cases, the doctor might also want to determine the type of human papillomavirus (HPV) causing the infection, which is a common cause of this skin condition.
If a skin rash does not improve with standard treatment, your doctor might recommend another skin biopsy to determine if the rash has developed into skin cancer.
Complete evaluation of HPV infection is very important. Your doctor would do a thorough examination of your mouth, genital area, and anus. If you engage in anal sex, your doctor might perform an anoscopy, a procedure that lets your doctor examine the inside of the anus, rectum, and lower part of the large intestine. It’s also necessary for your partner to undergo these same examinations to check for HPV infection.
Treatment Options for Bowenoid Papulosis
Treatment of Bowenoid papulosis, a skin disease that most often occurs in young people, seeks to stop the disease from becoming cancerous while maintaining healthy tissue and functioning. Since Bowenoid papulosis often goes away on its own, doctors usually take a wait-and-see approach. Without treatment, the small bumps or spots on the skin (the lesions) often disappear after approximately 8 months.
When treatment is necessary, there are a variety of procedures available, each intended to remove or destroy the lesions. These include carbon dioxide (CO2) laser treatment – where a high-powered laser is used to remove the lesions; cryotherapy – a procedure using extreme cold to destroy the lesions; electrocoagulation – a surgery that uses electricity to remove the lesions; photodynamic therapy – which uses a particular kind of light to destroy the lesions; excisional surgery – a procedure that cuts out the lesions; or 5 fluorouracil (5FU) – an anticancer drug that stops cells from multiplying.
For smaller Bowenoid papulosis lesions, applying a cream called imiquimod to the skin every other day for a month has shown positive results.
However, it’s important to know that recurrence or coming back of Bowenoid papulosis is common, regardless of the treatment used.
There are also preventive vaccines available to help avoid infection with the types of HPV known to cause cancer. Additionally, stopping smoking may help prevent the recurrence of Bowenoid papulosis.
What else can Bowenoid Papulosis be?
When a doctor is considering a diagnosis of bowenoid papulosis, they have to look at other conditions that might have similar symptoms before reaching a conclusion. Those conditions include:
- Genital warts
- Psoriasis
- Lichen planus
- Condylomata acuminate
- Seborrheic keratosis
- Pigmented Bowens disease
- Melanocytic Nevus
- Cutaneous squamous cell carcinoma
- Warty dyskeratoma
The doctor will have to exclude all these diseases based on the symptoms and tests before confirming a diagnosis of bowenoid papulosis.
What to expect with Bowenoid Papulosis
Bowenoid papulosis is a skin condition that can vary quite a bit. The spots it causes might disappear on their own or last for several years, especially in older people or those with weakened immune systems. In uncommon cases, it can lead to other more serious diseases like Bowen’s disease or invasive squamous cell carcinoma.
Possible Complications When Diagnosed with Bowenoid Papulosis
It’s pretty uncommon for invasive squamous cell carcinoma, a type of skin cancer, to develop. This happens in less than 1% of cases and is particularly seen in individuals with weakened immune systems. Females with skin condition Bowenoid papulosis, as well as sexual partners of male patients, have a higher risk of developing cervical or vulvar cancers. This increased risk is due to infection with a strain of HPV that has the potential to cause cancer.
Key Points:
- Invasive squamous cell carcinoma is a rare occurrence, happening in less than 1% of cases.
- People with weak immune systems are particularly at risk.
- Women with a skin condition called Bowenoid papulosis have an elevated risk.
- Sexual partners of male patients also have a higher chance of getting cervical or vulvar cancers.
- This is associated with infection with a type of HPV that can lead to cancer.
Preventing Bowenoid Papulosis
Bowenoid papulosis, a type of skin condition, doesn’t often develop into a more serious skin cancer known as invasive squamous cell carcinoma. Nevertheless, it’s very important that patients are aware there is a small chance this could happen. Patients should also learn about HPV (Human Papillomavirus) infections as they can be spread through sexual contact.
So, it’s recommended to avoid any direct sexual relations to decrease the chances of spreading the disease. Also, women who are partners of men with this condition should make sure they check in regularly with their doctor to ensure early detection of any possible problems.
