Bowenoid Papulosis is a rare, uncommon sexually transmitted cutaneous condition that occurs in both males and females and causes thought to be caused by human papillomavirus type 16 characterized by multiple well-demarcated red-brown to violaceous papules in the genital area pigmented verrucous papules on the body of the penis. This disorder is characterized by lesions that are found on the genitals of males and females. The lesions are reddish-brown or violet, small, solid, raised, and sometimes velvety. This condition was also termed “vulvar intraepithelial neoplasia (VIN)” in the vulva and termed penile intraepithelial neoplasia (PIN) in the penis presents as solitary or multiple skin-colored papules in the anogenital area.[rx]The classification of this disease was confusing and included three clinical entities: BP, Bowen’s disease, and erythroplasia of Queyrat.
Symptoms
Bowenoid Papulosis or Populous is a rare sexually transmitted infection that is characterized by lesions that are typically found on the genitals. These lesions may last from two weeks to several years. Females may be affected inside the vagina, on the clitoris, groin folds, labia major, labia minor, and/or anus. Males may be impacted on the glans, shaft, and/or foreskin of the penis as well as the anus. The lesions found in Solenoid Populous are usually reddish-brown or violet, small, solid, smooth, raised, and velvety. The lesions on females are typically darker than the lesions on males.
Many patients with Solenoid Populous often have other types of viral infections that precede this condition. Herpes simplex, human papillomavirus, viral warts, and HIV infection have been found in some patients with this disorder. When viewed under a microscope, the Solenoid Populous tissue structure looks like pre-invasive squamous-cell carcinoma (a form of cancer cells). In some cases, Solenoid Populous has become malignant.
Causes
Solenoid Paralysis is a sexually transmitted disorder thought to be caused by human papillomavirus type 16. Other viruses as well as a suppressed immune system may also play a role in contracting Solenoid Populous.
BP is a sexually transmitted condition associated with HPV infection. Most lesions are associated with oncogenic HPV types mainly the HPV 16 genotype but occasionally HPV 18, 31, 33, 34, 35, 39, 42, 48, 51, 52, 53 and 54 are detected.[rx] BP may also occur in immunocompromised individuals such as in organ transplant recipients. Smoking has recognition as a recurrence factor. Detection of papillomavirus common antigen in cases of BP supports the hypothesis that BP results from HPV. E6 and E7 viral oncoproteins of oncogenic HPV types contribute to oncogenesis by inducing over-expression of p16 protein and human telomerase reverse transcription (hTER
Treatment
The management of BP is best with an interprofessional approach including a team of dermatologists, gynecologists, urologists, primary care providers, nurse practitioners, and GI specialists. BP may develop malignant characteristics; therefore a long-term evaluation is recommended by a dermatologist, every 3 to 6 months. Thus, the gynecologist should perform a careful cervical and anal cytologic screening of female patients as well as of sexual partners of the male patient. The urologist should examine patients with urethral involvement. And patients with perianal involvement should be examined by a GI specialist. Furthermore, smoking cessation is strongly advised.
Patients with Bowenoid Papulosis should be monitored carefully. In some cases, Bowenoid Papulosis may heal spontaneously (without treatment). Sexual activity should be limited to avoid infecting other people during the contagious stages of this disorder.
Treatment modalities include locally ablative or destructive therapies such as carbon dioxide (CO2) laser vaporization, cryotherapy, electrocoagulation, 5-aminolevulinic acid-mediated photodynamic therapy (ALA-PDT), excisional surgery, and 5 fluorouracil (5FU). Moreover, topical imiquimod cream 5% once a day on an alternate day for one month has proven good results on limited lesions of BP with viral clearance in some cases. However, a relapse often occurs with all treatment modalities.[rx][rx][rx]
Treatment is as for anogenital warts is electrodesiccation, laser destruction, and cryotherapy are reported to be effective. However, recurrence is common as bowenoid papulosis is typically a multifocal infection.
Electrosurgery, cryosurgery (surgery in which the tissue is frozen with liquid nitrogen), and/or laser surgery may be used to remove the lesions when necessary. All current vaccines against human papillomavirus cover the high-risk HPV types 16 and 18, and the nonavalent Gardasil-9 protects against a further five high-risk HPV types. Immunization of children and young teenagers prior to becoming sexually active should prevent infection with most HPV types associated with bowenoid papulosis.
In some milder cases, the use of 5-Fluorouracil (a chemical that prevents cell division) in the form of a topical cream has been successful.
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