Bovenoid papulosis: causes, symptoms, diagnosis, treatment

Bowenoid papulosis is a combination of intraepithelial neoplasia with human papillomavirus infection. It manifests itself as multiple rashes in the genital area of reddish-brown or bluish color, slightly protruding above the skin surface, sometimes hyperpigmented. Many patients simultaneously have warts, condylomas, and simple vesicular lichen. It usually develops in adults, rarely in children. The course is usually benign, but transformation into squamous cell carcinoma is not excluded.

Pathomorphology of bowenoid papulosis. The histological picture resembles a pointed condyloma with cytological features of carcinoma in situ. This is confirmed by the presence of atypical epithelial cells, a large number of dyskeratotic cells, and mitotic figures in the epidermis. Large multinucleated epithelial cells, pronounced hyperkeratosis, and parakeratosis are found. The dermis shows dilation and tortuosity of capillary vessels, and inflammatory infiltrates, mainly of lymphocytes. However, this disease can be characterized by great histological variability. In some cases, the atypia of epithelial cells is insignificant, while in others it is sharply expressed against the background of high mitotic activity, as a result of which this disease cannot be differentiated from carcinoma in situ. Electron microscopy reveals a picture similar to that of Bowen's disease, and sometimes to that of a pointed condyloma. In individual foci in the nuclei of epithelial cells of the epidermis, virus-like particles with a diameter of 30-50 nm, similar in structure to the human papilloma virus, are found.

Histogenesis of bowenoid papulosis. The disease is mainly caused by types 16 and 18 of the human papillomavirus. Many patients have signs of primary immunodeficiency (not associated with HIV infection), mainly due to a decrease in the number of T-helpers.

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