Bowenoid papulosis is a skin infection caused by human papillomavirus. It causes papular changes of the skin in the genital region.
What is bowenoid papulosis?
In medicine, bowenoid papulosis also bears the technical name Condylomata plana. This refers to a skin infection whose causative agent is the human papillomavirus (HPV). Bowenoid papulosis is characterized by papular skin changes in the genital area. Bowenoid papulosis is considered both a symptom and an infection. In addition, the skin disease poses the risk of serious consequences. Human papilloma viruses can also cause carcinomas of the anus, penis and uterus. People between the ages of 20 and 40 are particularly affected by bowenoid papulosis. Bowenoid papulosis was first described in 1970, and a subtype of the disease affecting the region of the head and beard hair was also identified in 1978.
Causes
The originators of bowenoid papulosis are human papillomaviruses. More specifically, they come from HPV groups 16, 18, 31, and 33, which are subtypes (serotypes) of certain viruses that are considered high-risk types. Thus, these viruses are at risk of triggering the growth of a cancer. DNA from these high-risk serotypes can be detected in about 90 percent of all cervical dysplasias. Therefore, the pathogens are also thought to play a role in the pathogenesis of penile cancer and cervical cancer. Bowenoid papulosis, for example, is often considered a definite indication of infection with human papillomaviruses. Therefore, a physician should be consulted as soon as possible if this skin disease is suspected. Bowenoid papulosis is almost always transmitted through skin contact. As a rule, this involves unprotected sexual intercourse. Bowenoid papulosis is also one of the most common infections transmitted during sex. However, in many cases, the infection goes unnoticed. In rare cases, transmission of the human papillomavirus can also occur through towels that have been shared.
Symptoms, complaints, and signs
The typical feature of bowenoid papulosis is the appearance of papules with a red-brown coloration that are flat and velvety. These are the size of a pinhead or a lens and reach a diameter of between two and eight millimeters. The papules, which are sometimes macerated, appear primarily on the glans penis in males and on the large and small labia in females. However, these changes on the skin do not cause pain. Only in rare cases is there slight itching. Sometimes the affected persons do not even notice the infection because of this. Other patients usually undertake self-therapy. However, since there is a risk of transition to vulvar or penile carcinoma, treatment should be performed by a physician. In bowenoid papulosis, the papules often form within a short period of time. However, sometimes their growth occurs very slowly over years.
Diagnosis and course
If bowenoid papulosis is suspected, a trip to the doctor is unavoidable. An experienced physician will notice dyskeratotic cells in the dermis. They are considered to be the early stages of a carcinoma in situ. This is an epithelial tumor in which there is no invasive growth. Thus, it forms only intraepithelially. This circumstance allows to confirm the diagnosis of bowenoid papulosis. Another confirmation is the strong similarity to Bowen’s disease. In addition, there is the option of detecting the DNA of the human papillomaviruses by means of a polymerase chain reaction. Through hybridization as well as sequencing, it is also possible to determine the exact viral serotype of the HP viruses even before the first symptoms appear. However, if the viral concentration is too low, there is a risk of false negative results. The course of bowenoid papulosis varies. Spontaneous healing without medical treatment can sometimes occur after a few months. However, if the symptoms do not resolve, there is a risk of carcinoma formation, which in the worst case may even result in the death of the patient.
Complications
In many cases, bowenoid papulosis does not result in any other complications or symptoms.Patients recognize papules in the genital area. However, these are not identified in all cases. Many sufferers also initiate self-help measures to combat bowenoid papulosis. This is often successful, so that the papules disappear again and there are no further complaints. In severe cases, the symptom may progress to vulvar carcinoma or penile carcinoma. In this case, medical treatment is definitely necessary. In bowenoid papulosis, pain or itching occurs only in rare cases. Medical treatment takes place without complications and discomfort. It is mainly performed with lasers, which are used to remove the upper layers of the skin. This effectively combats bowenoid papulosis. There is no pain for the patient. However, it cannot be guaranteed that bowenoid papulosis will not recur. After the treatment, further examinations usually take place to verify the success of the treatment. To prevent further complications, young people should get vaccinated against HP viruses.
When should you go to the doctor?
Bowenoid papulosis is an infection with human papillomavirus (HPV). The infection can lead to serious late complications and must be treated promptly by a doctor. Possible complications are carcinomas of the anus, penis or uterus. Since the disease is contagious, an affected person should not only go to the doctor himself, but also motivate his sexual partners to do so. The incubation period, i.e. the time between infection and the outbreak of the disease, can be very long and last for several years. It is therefore usually no longer possible to determine from whom a person originally contracted the disease. However, if the carrier is known, the affected person should definitely be informed about the incident so that he or she can seek medical treatment. Patients recognize bowenoid papulosis by a number of symptoms. In women, these primarily include pinhead-sized, red-brown papules that form primarily on the labia minora and labia majora. The skin lesions are sometimes, but not always, accompanied by itching. In men, the papules appear mainly on the penis. Anyone who notices these symptoms should not hope that these skin changes will disappear by themselves, but should immediately consult a specialist in skin and sexually transmitted diseases. Women are best to consult their gynecologist.
Treatment and therapy
As a rule, the therapy of bowenoid papulosis is carried out by ablation of the skin lesions. To do this, the physician resorts to an electrocautery or a carbon dioxide laser. Electrocautery is the surgical cutting of tissue structures with the help of intense electric current. Another treatment option is the removal of papules by curettage or diathermy. Diathermy is also called high-frequency thermotherapy and is one of the electrotherapeutic procedures. With the help of electric current, heat is generated within the body tissue. The infected tissue can be separated and locally destroyed by the high-frequency current. Due to the strong blood supply to the genital tissue, diathermy is considered to be the most sensible method of therapy because it involves less bleeding. During curettage, the infected tissue is scraped out. Even after successful removal of the papules, regular follow-up examinations must take place because there is still a risk of malignant degeneration.
Outlook and prognosis
In general, the prognosis of bowenoid papulosis can be considered favorable. With the available options, palliation as well as cure of the disease can be achieved. The choice of therapeutic approach should be made according to the individual preferences of the patient, as good healing results can be achieved with conventional medicine and alternatives. The self-healing powers of a basically healthy person with a stable immune system are sufficient for recovery. Normally, freedom from symptoms is achieved within a few weeks. In patients with other diseases or psychological stress, medical care can greatly accelerate the healing process. A recurrence of bowenoid papulosis cannot be excluded in principle. The prospects of cure do not change even if the disease recurs. They continue to be good.In rare cases, bowenoid papulosis leads to the formation of carcinoma. This sequelae can have a fatal course without early and comprehensive medical supervision. Therefore, it is important that the patient undergoes a control examination and agrees to treatment as soon as possible in case of irregularities. The prognosis outlook with the carcinoma is critically dependent on the diagnosis and the existing health of the patient. With a weakened immune system, the organism has few resources that would be helpful for cancer therapy.
Prevention
To prevent bowenoid papulosis, general vaccination against HP virus is recommended. It is considered useful for girls and boys aged 12 to 17 years. In addition, it is advisable to protect oneself with a condom during sexual intercourse.
Aftercare
The person affected by this disease usually has very few or no special measures and options for aftercare. First and foremost, the disease itself must be treated so that further complications and complaints do not occur. Early diagnosis always has a positive effect on the further course of the disease and can also alleviate further complaints. In most cases, the person affected by this disease is dependent on regular treatment by a doctor, which should permanently alleviate the symptoms. Self-cure cannot occur in this case. In most cases, even after the removal of the papules or pustules, further control by the doctor is necessary. The affected areas should be wrapped in a bandage to prevent infections or other diseases. Further aftercare measures are usually not necessary. Since the disease can also lead to a malignant tumor, regular examinations by a doctor are also generally very useful in order to detect this tumor at an early stage and to continue to remove it. Some affected people are sometimes dependent on psychological treatment for this disease.
This is what you can do yourself
Patients with bowenoid papulosis first turn to a medical professional to speed up recovery from the disease. Usually, the doctor removes the papules using different procedures, and the patient must follow certain rules of conduct after the treatment. First of all, it is important not to have any other obligations on the day of the procedure and to refrain from physical activities, especially any kind of sports. The patient must discuss any exceptions with the attending physician. Depending on the severity of the surgical procedure, it may be beneficial for the healing of bowenoid papulosis if the patient allows himself physical rest for a few days and avoids additional mental stress. To support their own recovery, patients with bowenoid papulosis pay particular attention to appropriate personal hygiene. The doctor informs the patient about appropriate hygiene measures to avoid irritating the operated areas and to prevent complications. It is also extremely important that patients with bowenoid papulosis abstain from sexual intercourse. The duration of this abstinence is determined by the treating physician. Regular follow-up examinations help to monitor the healing process and, if necessary, to intervene in good time if complications arise. Sporting activities are also to be resumed following the surgical procedure only after consultation with the physician.