eMedicine Specialties > Dermatology > Viral Infections
Bowenoid Papulosis: Treatment & Medication
Updated: Dec 8, 2008
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Medical Care
- The most effective treatment for bowenoid papulosis is simple local destruction of the lesions. Various modalities have been used, although recurrences are common with all. The modalities include simple local excision, electrodesiccation, cryosurgery, laser surgery, and use of topical retinoic acid, podophyllum resin, and topical 5-fluorouracil.
- Immunomodulators have been reported as effective treatment for bowenoid papulosis and may lengthen the remission period of lesions. Among immunomodulators, 2 of the agents include imiquimod 5% and interferon.2,3,4,5 Application of interferon beta may decrease the relapse rate by reducing transcription of viral RNA oncogenes E6 and E7.
Consultations
- Dermatologist: Reexamine lesional skin serially every 3-6 months because of the possibility of transformation to Bowen disease or invasive squamous cell carcinoma. The risk of transformation is higher in patients who are immunocompromised and in elderly patients.
- Gynecologist: Female patients and women who have had sexual relations with male patients should be seen for a thorough cervical examination because of the increased risk of malignancy.
- Urologist: Patients with urethral involvement should consider receiving an examination by a urologist.
- Proctologist: Patients with perianal involvement should consider scheduling an examination with a proctologist.
Activity
- Condom use may decrease the risk of transmission.
- Patients with HPV infection may be lifelong carriers of the virus. Partners should have regular evaluations. Female partners should be evaluated regularly using Papanicolaou smears.
- In male partners, periodic anogenital examination may be of benefit.
Medication
Destruction of the lesion is the treatment of choice. Most medications act to some degree as both destructive and immunomodulating agents.
Keratolytic agents
Inhibit cell proliferation by blocking the progression of the cell cycle at specific stages.
Podophyllum resin (Pod-Ben, Podocon-25, Podofin)
Topical treatment for benign growths including external genital and perianal warts, papillomas, and fibroids.
Arrests mitosis in metaphase; active agent is podophyllotoxin; type of podophyllum resin used determines strength. American podophyllum contains one fourth of the amount reported by an Indian source.
Adult
Apply 10-25% concentration sparingly (1 drop at a time) onto lesions weekly (variations exist on frequency of treatment), allow drying between drops until area is covered
Treat only intact lesions; wash treatment area 1-2 h after first application; in subsequent treatments, patient can wait 4-6 h before washing off agent
Pediatric
Apply as in adults
None reported
Documented hypersensitivity; diabetes; impaired peripheral circulation; avoid use on mucous membranes, eyes, bleeding warts, moles, birthmarks, or unusual warts with hair
Pregnancy
X - Contraindicated; benefit does not outweigh risk
Precautions
Powerful caustic and severe irritant; do not use if surrounding tissue is swollen or irritated; 25% solution should not be applied near mucous membranes; do not use large amounts; avoid contact with cornea; systemic absorption of large quantities has resulted in toxicity, particularly polyneuritis, paralytic ileus, thrombocytopenia, and leukopenia; histologic changes can be noted in squamous cells, which can be misread as squamous cell carcinoma
Trichloroacetic acid (Tri-Chlor)
Cauterizes skin, keratin, and other tissues. Although caustic, causes less local irritation and systemic toxicity than others in the same class; however, response often is incomplete and recurrence occurs frequently.
Adult
Apply 25-50% topical liquid to lesion, wash off in 1-2 h; avoid uninvolved skin; can be used in anal areas; repeat q1-2wk
Pediatric
Not established
Topical medications that are irritants
Documented hypersensitivity; premalignant or malignant lesions
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
External use only; restrict use to treatment areas only; may cause pain, burning, erythema, and erosion
Imiquimod (Aldara)
Induces secretion of interferon alpha and other cytokines; mechanisms of action are unknown.
Adult
Apply overnight for 3 nights per wk; wash off in 6-10 h
Pediatric
Not established
Topical medications that are irritants
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Not recommended for treatment of rectal, cervical, intravaginal, urethral, and intra-anal HPV infection; following surgery or drug treatment, do not use topical imiquimod until genital/perianal tissue is healed; may cause local irritation and erythema
5-Fluorouracil cream (Efudex, Adrucil, Fluoroplex)
For treatment-resistant bowenoid papulosis. Interferes with DNA synthesis by blocking the methylation of deoxyuridylic acid, and inhibits thymidylate synthetase, which subsequently reduces cell proliferation.
Adult
Apply 5% cream overnight qwk for up to 10 wk; adjust dose in patients tolerant to skin irritation
Pediatric
Administer as in adults
None reported
Documented hypersensitivity; potentially serious infections
Pregnancy
X - Contraindicated; benefit does not outweigh risk
Precautions
Protect sensitive areas (eg, vulva, urethra, anus) using petroleum, zinc oxide, or 0.5% hydrocortisone as needed; inflammatory reactions may occur with occlusive dressings; porous gauze dressing may be applied for cosmetic reasons without increase in reaction; may cause pain, burning, erythema, and erosions
More on Bowenoid Papulosis |
| Overview: Bowenoid Papulosis |
| Differential Diagnoses & Workup: Bowenoid Papulosis |
Treatment & Medication: Bowenoid Papulosis |
| Follow-up: Bowenoid Papulosis |
| Multimedia: Bowenoid Papulosis |
| References |
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References
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].
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].
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].
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].
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].
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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].
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Grekin RC, Samlaska CP, Vin Christian K. Andrews Diseases of the Skin. 9th ed. Philadelphia, Pa: WB Saunders; 2000:515.
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].
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].
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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.
Further Reading
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
Treatment & Medication: Bowenoid Papulosis