Bowenoid Papulosis

Excerpt

Bowenoid papulosis is a premalignant skin condition transmitted through sexual contact and caused by oncogenic human papillomavirus (HPV) types. Lloyd first described the condition in 1970 as a pigmented Bowen disease of the groin in a young man. The lesions shared histologic features with Bowen disease but demonstrated distinct clinical characteristics. In 1977, Kopf and Bart reported multiple recurrent papules showing epidermal hyperplasia and atypical keratinocytes throughout the epithelium. The findings were consistent with squamous cell carcinoma in situ (SCCIS), and previous photochemotherapy was hypothesized as a contributing factor.

In 1978, Wade and colleagues examined genital lesions in young adults that resembled condylomas, lichen planus, or psoriasis. Histologic analysis revealed unequivocal features of SCCIS. The authors subsequently named the condition, previously described by Lloyd, Kopf, and Bart, as Bowenoid papulosis.

Bowenoid papulosis is caused by high-risk HPV serotypes, particularly 16 and 18. Additional contributing factors such as tobacco use, hormonal fluctuations, and local trauma have also been proposed. The condition primarily affects young adults, with a higher prevalence among men. Clinically, lesions appear as benign-appearing warty papules or plaques, occasionally violaceous in color, often mimicking lichen planus. Key differential diagnoses include lichen planus, condylomata acuminata, and psoriasis (see Image. Bowenoid Papulosis).

Diagnosis relies on clinical evaluation with confirmation by histologic examination. In contrast to Bowen disease, which frequently progresses to invasive squamous cell carcinoma (ISCC), Bowenoid papulosis rarely advances to invasive malignancy. Histologically, Bowenoid papulosis is now recognized as a high-grade squamous intraepithelial lesion (HSIL), typically exhibiting milder cytologic atypia than classic Bowen disease. Classification depends on anatomical location, such as the penis, vulva, or anal region. Treatment options include topical chemotherapeutic agents, ablative modalities, and surgical excision. The biological behavior and long-term course of Bowenoid papulosis are uncertain. However, most lesions respond to therapy or undergo spontaneous regression.