Lymphomatoid Papulosis|Bowenoid Papulosis Treatment,dysplasia,Causes,Symptoms: bowenoid papulosis is a sexually transmitted disease caused by the human papilloma virus, which is manifested by erythematous spots, papules or plaques and occurs with skin lesions of the genitals, perineum, perianal region or thighs. Bowenoid papulosis refers to precancerous conditions of the skin. Diagnosis of bovenoid papulosis is based on the clinical picture, PCR detection of human papillomavirus, negative serological reactions to syphilis, the results of histological examination. Treatment of Bowenoid papulosis consists of general antiviral therapy and removal of cutaneous elements with a laser, electrocoagulation, excision or cryodestruction.
bowenoid papulosis was initially described as a pigmented, multiple form of Bowen’s disease . Then its connection with the human papillomavirus was revealed. Men and women, mostly between the ages of 17 and 40, are susceptible to bovenoid papulosis. In clinical venereology, there were also isolated cases of bovenoid papulosis in children, including newborns whose mothers had this disease.
Bowenoid Papulosis is a relatively rare disease. Recently, however, there has been a tendency to an increase in the number of cases, which is associated with an increase in promiscuous sex relations in society.
Causes of Bowenoid Papulosis
The etiological factor of Bowenoid Papulosis is the human papillomavirus (HPV), which also causes the occurrence of warts , warts and papillomas . Most authors indicate a relationship of the disease with HPV types 16, 18, 31, 33. Separate studies indicate the detection of patients with bovenoid papulosis and other types of HPV.
Infection with bovenoid papulosis, like other sexually transmitted diseases ( gonorrhea , syphilis , chlamydia , ureaplasmosis , etc.) occurs through sexual intercourse. The incubation period can take from 2-3 months to several years.
Symptoms of Bowenoid Papulosis
Bowenoid papulosis rashes may be represented by red spots, pigmented or lichenoid papules similar to leukoplakia plaques. The elements can be multiple or single, ranging in size from a few millimeters to 3-3.5 cm. Usually they are not accompanied by subjective feelings, in some cases, patients complain of itching. With the development of inflammation appears pain.
Bowenoid Papulosis pigment papules have a red-brown, pink, purple or yellowish color. Their consistency is pasty, the surface is usually smooth, sometimes warty. Lichenoid papules of bovenoid papulosis are localized thickening of the skin with a strong and rough skin pattern. They often have the color of normal skin and a rough surface, may be covered with serous crusts. Individual papules merging together, form plaques. Leukoplakiyepodnye plaques are painted in a milky-white or grayish-white color, their edges are clearly delimited from healthy skin.
The most typical arrangement of elements of bovenoid papulosis in men is on the penis, in women – on the clitoris and labia. Localization is possible in the inguinal region, on the skin of the thighs and perineum, around the anus, on the mucous membrane of the mouth and throat. As a rule, pigmented papules are marked on the trunk of the penis in men, in the vulva and around the anus in women, and lichenoid on the head of the penis.
Along with manifestations of Bowenoid Papulosis, patients often have warts and genital warts. In women, a combination of bovenoid papulosis with cervical dysplasia occurs .
For Bowenoid Papulosis, a long course without progression of the process with periods of spontaneous remission is characteristic. In some cases, spontaneous resolution of the disease was observed. However, despite the seemingly harmless bovenoid papulosis, it belongs to precancerous skin diseases . There is always the possibility of transformation of its elements into squamous cell carcinoma of the genital organs, Bowen disease, penile cancer in men, or vulvar cancer in women. In connection with this, patients with bovenoid papulosis should be registered with a venereologist or dermatologist and regularly undergo examinations.
Diagnosis of Bowenoid Papulosis
Elements of Bowenoid Papulosis can be detected during the examination at the consultation of a gynecologist , urologist or andrologist. In such cases, the patient is sent to the venereologist, who establishes the diagnosis based on clinical data, the results of PCR diagnostics, cytological and histological examination of material obtained from the affected skin area.
PCR studies are aimed at identifying and typing human papillomavirus. They are carried out with scrapings, patient’s blood or smears taken from the genitals. To exclude the syphilitic nature of the skin elements, they are examined for pale treponema and serological diagnostics (RPR test, RIBT, RIF).
Cytological examination of a scraping or smear of elements of bovenoid papulosis reveals the presence of coilocytosis – a large number of epithelial cells with a characteristic clearing around the nucleus, as well as cells with doubled nuclei. The histological picture of bovenoid papulosis corresponds to in situ cancer. Proliferation of keratinocytes and atypical mitoses are observed. Polymorphic atypical cells with hyperchromic nuclei, characteristic of bovenoid papulosis, are diffusely dispersed throughout the entire epidermis, while in Bowen’s disease, these cells are located in compact groups.
Differential diagnosis of Bowenoid Papulosis is performed with syphilis, genital warts, psoriasis , lichen planus , Bowen’s disease, and common warts .
Treatment of Bowenoid Papulosis
The need for treatment of Bowenoid Papulosis is dictated by the probability of its malignancy. Cryodestruction, laser removal, electrocoagulation or surgical excision of the elements of Bowenoid Papulosis are performed. The application of cytostatics (Prospidium chloride, fluorouracil) on the affected skin or their chipping with interferon is also used. Local treatment of bovenoid papulosis is accompanied by general antiviral therapy.
It should be noted that Bowenoid Papulosis is prone to frequent recurrence and even its complex treatment is not always sufficiently effective.
Prevention of Bowenoid Papulosis
Measures aimed at preventing infection with the development of Bowenoid Papulosis are consistent with the general principles of STI prevention. These include, first and foremost, sensible sexual behavior and the use of a condom during sexual intercourse.