Medscape is available in 5 Language Editions – Choose your Edition here.


Bowenoid Papulosis

  • Author: Mary V Kaldas, MD; Chief Editor: Dirk M Elston, MD  more...
Updated: Sep 08, 2014


Bowenoid papulosis was described in 1977 by Kopf and Bart as papules on the penis. Bowenoid papulosis is now most commonly known to occur on the genitalia of both sexes in sexually active people. Bowenoid papulosis is manifested as papules that are induced virally by human papillomavirus (HPV) and demonstrate a distinctive histopathology (bowenoid dysplasia). Many bowenoid papulosis lesions appear to run a benign course, although a number of case reports associate bowenoid papulosis with malignant invasive transformation (2.6%).

Bowenoid papulosis may be considered to be a transitional state between a genital wart and Bowen disease. The rate of transformation of bowenoid papulosis lesions is unknown. Clearly, bowenoid papulosis lesions have some malignant potential, but they may be treated with locally destructive modalities, sparing the surrounding tissues. Bowenoid papulosis lesions often are multifocal, and patients should be observed for recurrence and for the possibility of invasive or in situ malignancy.



Bowenoid papulosis is an asymptomatic focal epidermal hyperplasia and dysplasia induced by HPV infection[1] (most commonly by HPV 16). The result can appear as a papule or multiple papules that sometimes coalesce, as patches, or as plaques. Histologically, they are composed of scattered atypical cells or full-thickness epidermal atypia that some view as analogous to squamous cell carcinoma in situ. This epidermal atypia is sometimes known as bowenoid dysplasia.




United States

Bowenoid papulosis lesions are related clinically to genital warts. They share the same age of onset in patients and are transmitted sexually. Because bowenoid papulosis lesions frequently are treated destructively as warts and without histopathologic examination, the true frequency of bowenoid papulosis is unknown but is believed to be underestimated. With locally destructive therapy, the risk of invasive carcinoma in bowenoid papulosis appears to be low.


Cervical bowenoid papulosis lesions are associated with an increased incidence of abnormal cervical smears. Although bowenoid papulosis has a low rate of developing invasive characteristics (2.6%), yearly serial examinations are recommended because of the possibility of recurrence.


Bowenoid papulosis affects all races equally.


The male-to-female ratio for bowenoid papulosis is equal.


Bowenoid papulosis occurs primarily in young, sexually active adults, with a mean age of 31 years. However, reported cases show children as young as 2 years who are affected. One case of a 3-year-old girl[2] with bowenoid papulosis and another case of a 9-year-old girl with vertically acquired HIV and bowenoid papulosis[3] have been reported.

Contributor Information and Disclosures

Mary V Kaldas, MD Resident Physician in Anatomic Pathology, National Institutes of Health

Disclosure: Nothing to disclose.


Mark P Eid, MD Founder and Director, Virginia Dermatology and Skin Surgery Center

Mark P Eid, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, Pennsylvania Academy of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Lester F Libow, MD Dermatopathologist, South Texas Dermatopathology Laboratory

Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Texas Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Mark W Cobb, MD Consulting Staff, WNC Dermatological Associates

Mark W Cobb, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Society of Dermatopathology

Disclosure: Nothing to disclose.


Edward A DiPreta, MD Dermatologist, DiPreta Dermatology

Edward A DiPreta, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, American Society for MOHS Surgery, and Medical Association of Georgia

Disclosure: Nothing to disclose.

Kurt Maggio, MD Director of Dermatologic Surgery and Cutaneous Oncology, Assistant Chief, Department of Dermatology, Walter Reed Army Medical Center

Disclosure: Nothing to disclose.

  1. Zhou L, Kang D, Xu C, Zhao W, Tian B, Chen L. Expression of cyclin D1 and cyclin E significantly associates with human papillomavirus subtypes in Bowenoid papulosis. Acta Histochem. 2013 May. 115(4):339-43. [Medline].

  2. Halasz C, Silvers D, Crum CP. Bowenoid papulosis in three-year-old girl. J Am Acad Dermatol. 1986 Feb. 14(2 Pt 2):326-30. [Medline].

  3. Godfrey JC, Vaughan MC, Williams JV. Successful treatment of bowenoid papulosis in a 9-year-old girl with vertically acquired human immunodeficiency virus. Pediatrics. 2003 Jul. 112(1 Pt 1):e73-6. [Medline].

  4. Feng J, Wu F, Liu F, Deng D, Chen J, Zeng M, et al. Spontaneous regression of bowenoid papulosis. Dermatol Online J. 2013 May 15. 19(5):18185. [Medline].

  5. Rüdlinger R, Grob R, Yu YX, Schnyder UW. Human papillomavirus-35-positive bowenoid papulosis of the anogenital area and concurrent human papillomavirus-35-positive verruca with bowenoid dysplasia of the periungual area. Arch Dermatol. 1989 May. 125(5):655-9. [Medline].

  6. Fader DJ, Stoler MH, Anderson TF. Isolated extragenital HPV-thirties-group-positive bowenoid papulosis in an AIDS patient. Br J Dermatol. 1994 Oct. 131(4):577-80. [Medline].

  7. Johnson TM, Saluja A, Fader D, et al. Isolated extragenital bowenoid papulosis of the neck. J Am Acad Dermatol. 1999 Nov. 41(5 Pt 2):867-70. [Medline].

  8. Kratochvil FJ, Cioffi GA, Auclair PL, Rathbun WA. Virus-associated dysplasia (bowenoid papulosis?) of the oral cavity. Oral Surg Oral Med Oral Pathol. 1989 Sep. 68(3):312-6. [Medline].

  9. Lee HJ, Shin DH, Choi JS, Kim KH. A case of isolated bowenoid papulosis of the nipple. Ann Dermatol. 2014 Jun. 26(3):381-4. [Medline]. [Full Text].

  10. Dubina M, Goldenberg G. Viral-associated nonmelanoma skin cancers: a review. Am J Dermatopathol. 2009 Aug. 31(6):561-73. [Medline].

  11. Xu X, Erickson L, Chen L, Elder DE. Diseases Caused by Viruses. Lever's Histopathology of Skin. 10th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2009. 65-7.

  12. Kazlouskaya V, Shustef E, Allam SH, Lal K, Elston D. Expression of p16 protein in lesional and perilesional condyloma acuminata and bowenoid papulosis: clinical significance and diagnostic implications. J Am Acad Dermatol. 2013 Sep. 69(3):444-9. [Medline].

  13. Shimizu A, Kato M, Ishikawa O. Bowenoid papulosis successfully treated with imiquimod 5% cream. J Dermatol. 2014 Jun. 41(6):545-6. [Medline].

  14. Goorney BP, Polori R. A case of Bowenoid papulosis of the penis successfully treated with topical imiquimod cream 5%. Int J STD AIDS. 2004 Dec. 15(12):833-5. [Medline].

  15. Lucker GP, Speel EJ, Creytens DH, et al. Differences in imiquimod treatment outcome in two patients with bowenoid papulosis containing either episomal or integrated human papillomavirus 16. J Invest Dermatol. 2007 Mar. 127(3):727-9. [Medline].

  16. Orengo I, Rosen T, Guill CK. Treatment of squamous cell carcinoma in situ of the penis with 5% imiquimod cream: a case report. J Am Acad Dermatol. 2002 Oct. 47(4 Suppl):S225-8. [Medline].

  17. Ricart JM, Cordoba J, Hernandez M, Esplugues I. Extensive genital bowenoid papulosis responding to imiquimod. J Eur Acad Dermatol Venereol. 2007 Jan. 21(1):113-5. [Medline].

  18. Shastry V, Betkerur J, Kushalappa. Bowenoid papulosis of the genitalia successfully treated with topical tazarotene: a report of two cases. Indian J Dermatol. 2009 Jul. 54(3):283-6. [Medline]. [Full Text].

  19. Lim JH, Lim KS, Chong WS. Dramatic Clearance of HIV-Associated Bowenoid Papulosis Using Combined OralAcitretin and Topical 5% Imiquimod. J Drugs Dermatol. 2014 Aug 1. 13(8):901-902. [Medline].

  20. Bourgault Villada I, Moyal Barracco M, Berville S, et al. Human papillomavirus 16-specific T cell responses in classic HPV-related vulvar intra-epithelial neoplasia. Determination of strongly immunogenic regions from E6 and E7 proteins. Clin Exp Immunol. 2010 Jan. 159(1):45-56. [Medline]. [Full Text].

  21. Champion RH, Burton JL, Burns DA. Rook/Wilkinson/Ebling Textbook of Dermatology. 6th ed. London, UK: Blackwell Science; 1998. Vols 1-2: 1047, 1676, 3197-8, 3233.

  22. de Belilovsky C, Lessana-Leibowitch M. [Bowen's disease and bowenoid papulosis: comparative clinical, viral, and disease progression aspects]. Contracept Fertil Sex. 1993 Mar. 21(3):231-6. [Medline].

  23. Grekin RC, Samlaska CP, Vin Christian K. Andrews Diseases of the Skin. 9th ed. Philadelphia, Pa: WB Saunders; 2000. 515.

  24. Schwartz RA, Stoll HL. Epithelial precancerous lesions. Freedberg IM, Fitzpatrick T, eds. Fitzpatrick's Dermatology in General Medicine. 5th ed. New York, NY: McGraw-Hill; 1999. Vol 1: 831-2.

Bowenoid papulosa histopathology (hematoxylin and eosin, magnification 40X).
Bowenoid papulosa histopathology (hematoxylin and eosin, magnification 400X).
Typical appearance of bowenoid papulosis in the female.
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.