Bowenoid papulosis is a sexually transmitted disease caused by the human papillomavirus, manifested by erythematous spots, papules or plaques and occurring with skin lesions of the genitals, perineum, perianal region or thighs. The disease refers to precancerous skin conditions. Diagnosis is based on the clinical picture, PCR detection of human papillomavirus, negative serological reactions to syphilis, the results of histological examination. Treatment consists of general antiviral therapy and removal of cutaneous elements by laser, electrocoagulation, excision or cryodestruction.
Bowenoid papulosis was initially described as a pigmented multiple form of Bowen’s disease. Then its connection with the human papillomavirus was revealed. Men and women are susceptible to the disease, mainly at the age of 17-40 years. In clinical venereology, there have also been isolated cases of occurrence in children, including in newborns whose mothers had this disease.
Bowenoid pappulosis is a relatively rare disease. However, recently there has been a tendency to increase the number of cases, which is associated with the growth of promiscuous sexual relations in society.
Causes of bowenoid papulosis
The etiological factor is the human papillomavirus (HPV), which also causes the appearance of warts, warts and papillomas. Most authors point to the connection of the disease with HPV types 16, 18, 31, 33. Separate studies indicate the detection of other types of HPV in patients with bowenoid papulosis.
Infection with bowenoid papulosis, like other sexually transmitted diseases (gonorrhea, syphilis, chlamydia, ureaplasmosis, etc.) occurs sexually. The incubation period can take from 2-3 months to several years.
Symptoms of bowenoid papulosis
Rashes can be represented by red spots, pigmented or lichenoid papules, similar to leukoplakia plaques. Elements can have multiple or single character, size from a few millimeters to 3-3.5 cm. Usually they are not accompanied by subjective sensations, in some cases patients complain of itching. With the development of inflammation, soreness appears.
Pigmented papules have a red-brown, pink, purple or yellowish color. Their consistency is testy, the surface is usually smooth, sometimes warty. Lichenoid papules are local thickening of the skin with a reinforced and rough skin pattern. They often have the color of ordinary skin and a rough surface, may be covered with serous crusts. Individual papules merging with each other, form plaques. Leukoplakie-like plaques are colored milky white or grayish-white, their edges are clearly delimited from healthy skin.
The most typical arrangement of elements of bowenoid papulosis in men is on the penis, in women – on the clitoris and labia. Localization is possible in the groin area, on the skin of the thighs and perineum, around the anus, on the mucous membrane of the mouth and pharynx. As a rule, pigmented papules are noted on the trunk of the penis in men, in the vulva and around the anus in women, and lichenoid papules are noted on the head of the penis.
Simultaneously with the manifestations of bowenoid papulosis, warts and genital warts are often observed in patients. In women, there is a combination of bowenoid papulosis with cervical dysplasia.
Bowenoid papulosis is characterized by a long course without progression of the process with periods of spontaneous remissions. In some cases, spontaneous resolution of the disease was observed. However, despite its apparent inoffensiveness, it refers to precancerous skin diseases. There is always a possibility of transformation of its elements into squamous cell carcinoma of the skin of the genitals, Bowen’s disease, penile cancer in men or vulvar cancer in women. In this regard, these patients should be registered at a dispensary with a venereologist or dermatologist and undergo regular examinations.
Elements of bowenoid papulosis can be detected during an examination at the consultation of a gynecologist, urologist or andrologist. In such cases, the patient is referred to a venereologist, who establishes the diagnosis based on clinical data, the results of PCR diagnostics, cytological and histological examination of the material obtained from the affected area of the skin.
PCR studies are aimed at identifying and typing the human papillomavirus. They are carried out with scraping, patient’s blood or smears taken from the genitals. To exclude the syphilitic nature of the skin elements, they are examined for pale treponema, serological diagnostics.
Cytological examination of scraping or smear-imprint of elements of bowenoid papulosis reveals the presence of coilocytosis — a large number of epithelial cells with characteristic enlightenment around the nucleus, as well as cells with doubled nuclei. The histological picture of bowenoid papulosis corresponds to cancer in situ. Keratinocyte proliferation and atypical mitoses are observed. Polymorphic atypical cells with hyperchromic nuclei characteristic of bowenoid papulosis are diffusely scattered throughout the thickness of the epidermis, while in Bowen’s disease such cells are located in compact groups.
Differential diagnosis is carried out with syphilis, genital warts, psoriasis, lichen planus, Bowen’s disease, common warts.
Bowenoid papulosis treatment
The need for treatment of bowenoid papulosis is dictated by the probability of its malignancy. Cryodestruction, laser removal, electrocoagulation or surgical excision of elements of bowenoid papulosis is performed. It is also used to apply cytostatics (prospidium chloride, fluorouracil) to the affected areas of the skin or their pricking with interferon. Local treatment is accompanied by general antiviral therapy.
It should be noted that the disease is prone to frequent recurrence and even its complex treatment is not always effective enough.
Measures aimed at preventing infection with development comply with the general principles of STI prevention. These include, first of all, reasonable sexual behavior and the use of a condom during sexual contact.
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