Background
Bowenoid papulosis was described in 1977 by Kopf and Bart as papules on the penis. Bowenoid papulosis is now most commonly known to occur on the genitalia of both sexes in sexually active people. Bowenoid papulosis is manifested as papules that are induced virally by human papillomavirus (HPV) and demonstrate a distinctive histopathology (bowenoid dysplasia). [1] Many bowenoid papulosis lesions appear to run a benign course, although a number of case reports associate bowenoid papulosis with malignant invasive transformation (2.6%).
Bowenoid papulosis may be considered to be a transitional state between a genital wart and Bowen disease. The rate of transformation of bowenoid papulosis lesions is unknown. Clearly, bowenoid papulosis lesions have some malignant potential, but they may be treated with locally destructive modalities, sparing the surrounding tissues. Bowenoid papulosis lesions often are multifocal, and patients should be observed for recurrence and for the possibility of invasive or in situ malignancy.
Pathophysiology
Bowenoid papulosis is an asymptomatic focal epidermal hyperplasia and dysplasia induced by HPV infection [2, 3] (most commonly by HPV 16). The result can appear as a papule or multiple papules that sometimes coalesce, as patches, or as plaques. Histologically, they are composed of scattered atypical cells or full-thickness epidermal atypia that some view as analogous to squamous cell carcinoma in situ. This epidermal atypia is sometimes known as bowenoid dysplasia.
Etiology
HPV, particularly HPV 16, has been linked closely to bowenoid papulosis. [4] Other HPV types implicated include 18, 31, 32, 33, 34, 35, 39, 42, 48, 51, 52, 53, and 54. Consequently, the risk of acquiring bowenoid papulosis is identical to that for other genital HPV-associated conditions via sexual contact or, possibly, via vertical transmission from mother to newborn.
Epidemiology
Frequency
Bowenoid papulosis lesions are related clinically to genital warts. They share the same age of onset in patients and are transmitted sexually. Because bowenoid papulosis lesions frequently are treated destructively as warts and without histopathologic examination, the true frequency of bowenoid papulosis is unknown but is believed to be underestimated. With locally destructive therapy, the risk of invasive carcinoma in bowenoid papulosis appears to be low.
Race
Bowenoid papulosis affects all races equally.
Sex
The male-to-female ratio for bowenoid papulosis is equal.
Age
Bowenoid papulosis occurs primarily in young, sexually active adults, with a mean age of 31 years. However, reported cases show children as young as 2 years who are affected. One case of a 3-year-old girl [5] with bowenoid papulosis and another case of a 9-year-old girl with vertically acquired HIV and bowenoid papulosis [6] have been reported.
Prognosis
Prognosis for bowenoid papulosis is variable. Younger patients tend to have a self-limiting course lasting months. Patients who are older or immunocompromised can have a protracted course lasting years and, possibly, no resolution.
Cervical bowenoid papulosis lesions are associated with an increased incidence of abnormal cervical smears. Although bowenoid papulosis has a low rate of developing invasive characteristics (2.6%), yearly serial examinations are recommended because of the possibility of recurrence.
Patient Education
Educate patients regarding the malignant potential of bowenoid papulosis and the avoidance of direct sexual contact to decrease transmission of the disease.
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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.
