Medical Care
Conservative treatment is often considered, as bowenoid papulosis has been known to regress spontaneously. [5]
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. [16, 17]
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% [18] and interferon. [19, 20, 21, 22] 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. [23] Another report shows an extensive case of bowenoid papulosis improving after 8 weeks of treatment with combined oral acitretin and topical 5% Imiquimod. [24]
Without treatment, regression can take up to 8 months. [14] However, treatment times may vary, with reported cases showing 2-6 months before regression. [18, 24]
Consultations
The following consultations may be warranted:
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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.
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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.
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Urologist: Patients with urethral involvement should consider receiving an examination by a urologist.
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Proctologist: Patients with perianal involvement should consider scheduling an examination with a proctologist.
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.
Prevention
Advise bowenoid papulosis patients to avoid direct contact with lesions.
Advise bowenoid papulosis patients to seek prompt treatment.
Bourgault Villada et al determined that regions from proteins E6 and E7 are strongly immunogenic, which may have implications for the development of an HPV-16 vaccine. [25]
Long-Term Monitoring
Perform serial examinations. Bowenoid papulosis may show malignant change; therefore, follow-up treatment is warranted every 3-6 months if the lesions recur or do not resolve.
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Bowenoid papulosa histopathology (hematoxylin and eosin, magnification 40X).
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Bowenoid papulosa histopathology (hematoxylin and eosin, magnification 400X).
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Typical appearance of bowenoid papulosis in the female.
