Bowenoid Papulosis Treatment & Management

  • Author: Edward A DiPreta, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Apr 29, 2010
 

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.[3, 4, 5, 6] Application of interferon beta may decrease the relapse rate by reducing transcription of viral RNA oncogenes E6 and E7.
  • One report describes 2 cases of genital bowenoid papulosis successfully treated with tazarotene.[7]
  • Also see the Centers for Disease Control and Prevention treatment guidelines, HPV infection and genital warts. Sexually transmitted diseases treatment guidelines 2006.
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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.
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Activity

  • Condom use may decrease the risk of bowenoid papulosis 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.
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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: Nothing to disclose.

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.

Specialty Editor Board

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.

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.

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.

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 Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

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.

References

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

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

  3. 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].

  4. 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. Mar 2007;127(3):727-9. [Medline].

  5. 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].

  6. 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].

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

  8. 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. Jan 2010;159(1):45-56. [Medline].

  9. 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.

  10. 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].

  11. Eileen M. Burd. Human Papillomavirus and Cervical Cancer. Clin Microbiol rev. January 2003;16(1):1-17. [Full Text].

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

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

  14. 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].

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

  16. 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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Bowenoid papulosa histopathology (hematoxylin and eosin, magnification 40X).
Bowenoid papulosa histopathology (hematoxylin and eosin, magnification 400X).
Typical appearance of bowenoid papulosis in the female.
 
 
 
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