eMedicine Specialties > Dermatology > Viral Infections

Bowenoid Papulosis

Author: Edward A DiPreta, MD, Dermatologist, Brunswick Dermatology
Coauthor(s): Kurt Maggio, MD, Director of Dermatologic Surgery and Cutaneous Oncology, Assistant Chief, Department of Dermatology, Walter Reed Army Medical Center
Contributor Information and Disclosures

Updated: Dec 8, 2008

Introduction

Background

Originally described in 1977 by Kopf and Bart as papules on the penis, bowenoid papulosis (BP) now is 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 of the 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 is unknown. Clearly, lesions have some malignant potential, but they may be treated with locally destructive modalities, sparing the surrounding tissues. The lesions often are multifocal, and patients should be observed for recurrence and for the possibility of invasive or in situ malignancy.

The Medscape HPV and Cervical Cancer Resource Center may be of interest.

Pathophysiology

Bowenoid papulosis is a focal epidermal hyperplasia and dysplasia induced by HPV infection (most commonly by HPV 16). The result is a papule demonstrating 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.

Frequency

United States

Bowenoid papulosis lesions are related clinically to genital warts. They share the same age of onset in patients and are transmitted sexually. Since 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 appears to be low.

Mortality/Morbidity

Cervical 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.

Race

Bowenoid papulosis affects all races equally.

Sex

The male-to-female ratio is equal.

Age

The disease occurs primarily in young, sexually active adults, with a mean age of 31 years.

Clinical

History

Bowenoid papulosis typically occurs in young sexually active persons. The disease tends to be benign with spontaneous regression occurring within several months. A more protracted course is believed to occur in older patients and, possibly, with lesions consistent with certain HPV types. These lesions may last as long as 5 years, or they may never regress completely. The lesions tend to be asymptomatic but can be inflamed, pruritic, or painful.

Physical

Bowenoid papulosis presents as solitary or multiple, small, pigmented (red, brown, or flesh-colored) papules with a flat-to-verrucous surface. The lesions can coalesce into larger plaques. Lesions occur most commonly on the shaft of the penis or the external genitalia of females, although they can occur anywhere on the genitalia and in the perianal region. Of note, 6 cases of nongenital bowenoid papulosis have been reported.1

Causes

HPV, particularly HPV 16, has been linked closely to bowenoid papulosis. Other HPV types implicated include 18, 31, 32, 33, 34, 35, 39, 42, 48, 51, 52, 53, and 54. Consequently, the risk of acquiring bowenoid papulosis is identical to that for other genital HPV-associated conditions via sexual contact or, possibly, via vertical transmission from mother to newborn.

More on Bowenoid Papulosis

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Multimedia: Bowenoid Papulosis
References
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References

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

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

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

  4. 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. Oct 2002;47(4 Suppl):S225-8. [Medline].

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

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

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

  8. Elder D, Elenitsas R, Jaworsky C. Lever's Histopathology of the Skin. 8th ed. Philadelphia, Pa: Lippincott-Raven; 1997:579, 584-6.

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

  10. Majewski S, Jablonska S. Human papillomavirus-associated tumors of the skin and mucosa. J Am Acad Dermatol. May 1997;36(5 Pt 1):659-85; quiz 686-8. [Medline].

  11. Patterson JW, Kao GF, Graham JH, Helwig EB. Bowenoid papulosis. A clinicopathologic study with ultrastructural observations. Cancer. Feb 15 1986;57(4):823-36. [Medline].

  12. Schwartz RA, Janniger CK. Bowenoid papulosis. J Am Acad Dermatol. Feb 1991;24(2 Pt 1):261-4. [Medline].

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

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Further Reading

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Keywords

bowenoid papulosis, human papillomavirus, human papilloma virus, HPV, viral keratosis, bowenoid papulosis of the penis, bowenoid papulosis of the genitalia, multifocal indolent pigmented penile papules

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Contributor Information and Disclosures

Author

Edward A DiPreta, MD, Dermatologist, Brunswick Dermatology
Edward A DiPreta, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: medicis Consulting fee Review panel membership

Coauthor(s)

Kurt Maggio, MD, Director of Dermatologic Surgery and Cutaneous Oncology, Assistant Chief, Department of Dermatology, Walter Reed Army Medical Center
Disclosure: Nothing to disclose.

Medical Editor

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, and American Society of Dermatopathology
Disclosure: Nothing to disclose.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

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, and Texas Medical Association
Disclosure: Nothing to disclose.

CME Editor

Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology
Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds None; Genentech Consulting fee Consulting; Centocor Consulting fee Consulting; Centocor Grant/research funds None; Covance Consulting fee Consulting; Shire  Consulting

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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