eMedicine Specialties > Dermatology > Viral Infections

Bowenoid Papulosis: Treatment & Medication

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

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

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

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

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

  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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