Case and Research Letter
Periungual Bowenoid Papulosis Due to Human Papillomavirus Type 42
Papulosis bowenoide periungueal por virus del papiloma humano 42
Servicio de Dermatología, Hospital Municipal de Badalona, Badalona Serveis Assistencials, Barcelona, Spain
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Gómez Vázquez, R. Navarra Amayuelas" "autores" => array:2 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Gómez Vázquez" "email" => array:1 [ 0 => "mergova@terra.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Navarra Amayuelas" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Municipal de Badalona, Badalona Serveis Assistencials, Barcelona, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Papulosis bowenoide periungueal por virus del papiloma humano 42" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1328 "Ancho" => 1000 "Tamanyo" => 494243 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hypoplastic epidermis with loss of normal cell architecture, moderate cellular atypia, dyskeratosis, and koilocytes (hematoxylin-eosin, original magnification ×40).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 28-year-old man with no relevant past medical history consulted for a progressive, slow-growing exophytic lesion at the edge of the nail of the middle finger on the left hand. The lesion had been present for 2 years. The patient reported that he had had multiple sexual partners up to 6 years earlier.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Physical examination revealed a red-grayish exophytic periungual lesion measuring 0.7<span class="elsevierStyleHsp" style=""></span>cm in diameter with a hyperkeratotic surface (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Histopathologic examination showed a hyperplastic epidermis with loss of normal cell architecture, moderate cellular atypia, dyskeratosis, and koilocytes in the epidermis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Overexpression of the tumor suppressor protein p16 was also observed (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Based on a diagnosis of extragenital bowenoid papulosis, the patient was re-questioned, but he reported that neither he nor his current partner had had genital or anal warts. Lymphocyte counts (including CD4 and CD8 counts) were normal and serologic testing for human immunodeficiency virus (HIV) was negative. Human papillomavirus (HPV) DNA testing using the hybrid capture assay detected HPV 42. It was decided to excise the entire lesion and schedule periodic follow-up visits for the patient and his partner. The patient was asymptomatic a year after diagnosis.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The term <span class="elsevierStyleItalic">bowenoid papulosis</span> was introduced to describe multiple wart-like papules in the genital region that are histologically similar to Bowen disease and clinically similar to genital warts. The condition typically affects young, sexually active individuals and mainly involves the genital, crural, and perianal regions. However, there have also been reports of extragenital bowenoid papulosis with or without concomitant genital lesions in both immunocompetent and immunodeficient patients.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Bowenoid papulosis is associated with HPV infection. While there is a close link with HPV 16 infection,<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> types 18, 31-35, 39, 42, 48, and 51-54 have also been implicated.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–4</span></a> HPV 16, 18, and 33 are considered to have the greatest oncogenic potential.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Bowenoid papulosis is considered to be a squamous cell carcinoma in situ and has an estimated risk of malignant transformation of 2.6%.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The oncogenic mechanism is probably initiated by HPV-induced genetic changes in infected cells. High-risk serotypes produce HPV oncoproteins E6 and E7, which are capable of inactivating the Rb and p53 tumor suppressor proteins, respectively, giving rise to uncontrolled cell proliferation.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> HPV has been detected in bowenoid papulosis lesions and adjacent healthy skin, indicating that HPV infection is a necessary but not sufficient factor in the development of bowenoid papulosis. Other alterations, such as additional genetic mutations in the host cell, may be necessary.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Bowen papulosis is histologically similar to Bowen disease, but exhibits more focal and less intense changes.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,5,6</span></a> To distinguish between the 2 entities, it is always necessary to correlate clinical and histologic findings.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The prevalence of Bowenoid papulosis is unknown, as the lesions are commonly confused with other wart-like lesions and are frequently destroyed without histological examination.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Since the lesions tend to recur and have malignant potential, patients and their sexual partners should be referred for periodic follow-up and an immunological study in the case of persistent or recurrent lesions.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> The clinical course is variable, with some lesions progressing to chronic or malignant forms and others spontaneously regressing. Conservative treatment involving destruction of the lesions by simple excision, electrocoagulation, or cryosurgery is the most effective therapeutic approach.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,8</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Bowenoid papulosis generally occurs with concomitant genital lesions or in patients with a history of HPV-induced lesions<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8–10</span></a> (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).Transmission is believed to occur through direct contact, autoinoculation, or fomites.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2,7,9</span></a> These transmission mechanisms would explain the involvement of different parts of the body. Reports in the literature describe lesions affecting the neck, the abdomen, the shoulder, the chin, and the periungual area, among others.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–10</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">We have reported a new case of bowenoid papulosis affecting the periungual area of a finger in a patient with no past or present history of genital lesions. Two similar cases of extragenital bowenoid papulosis have been reported in the literature. One of the patients had bowenoid papulosis lesions in the perianal area that were detected on diagnosis of the nail lesion<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> and the other patient had HIV infection.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> We believe that lesions in young sexually active patients should be examined histologically, even when they are located at a distance from the genital region. The possibility of immunosuppressive conditions should be investigated, as should the presence of genital lesions in the patients and their partners.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Gómez Vázquez M, Navarra Amayuelas R. Papulosis bowenoide periungueal por virus del papiloma humano 42. Actas Dermosifiliogr. 2013;104:932–934.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 394 "Ancho" => 866 "Tamanyo" => 46787 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Red-grayish exophytic periungual lesion with a hyperkeratotic surface.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1328 "Ancho" => 1000 "Tamanyo" => 494243 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Hypoplastic epidermis with loss of normal cell architecture, moderate cellular atypia, dyskeratosis, and koilocytes (hematoxylin-eosin, original magnification ×40).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 979 "Ancho" => 1300 "Tamanyo" => 345751 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Overexpression of tumor suppressor protein p16.</p>" ] ] 3 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Abbreviation: HIV, human immunodeficiency virus; HPV, human papillomavirus.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Cases \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Immunodeficiency \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Site \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">HPV Detected \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Transmission \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Genital Lesions \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bart<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not known \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not tested \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Not known \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grussendorg-Conen<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Neck \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HPV 16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Rüdlinger et al.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Periungual \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HPV 35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Direct contact \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grob et al.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Neck \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HPV 16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Razor \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Johnson et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Neck \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Razor \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fader et al.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HIV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Neck \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HPV 31, 33, 35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Razor \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes (in the past) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Baron et al.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Neck \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Purnell et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Idiopathic CD4<span class="elsevierStyleSup">+</span> lymphocytopenia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Finger \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Papadopoulos et al.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NoHIV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ShoulderAbdomen \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6, 1, 42, 43, 44Not identified \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NoNo \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oh et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Toe webs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Tinea pedis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Our case \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Periungual \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab430514.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A Selection of Published Cases of Extragenital Bowenoid Papulosis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Isolated extragenital bowenoid papulosis of the neck" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T.M. Johnson" 1 => "A. Saluja" 2 => "D. Fader" 3 => "D. Blum" 4 => "J. Cotton" 5 => "T.S. Wang" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "1999" "volumen" => "41" "paginaInicial" => "867" "paginaFinal" => "870" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10534673" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Isolated extragenital HPV-thirties-group-positive bowenoid papulosis in an AIDS patient" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D.J. Fader" 1 => "M.H. Stoler" 2 => "T.F. Anderson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Br J Dermatol" "fecha" => "1994" "volumen" => "131" "paginaInicial" => "577" "paginaFinal" => "580" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7947214" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Human papillomavirus-35-positive bowenoid papulosis of the anogenital area and concurrent human papillomavirus-35-positive verruca with bowenoid dysplasia of the periungual area" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. Rüdlinger" 1 => "R. Grob" 2 => "X.Y. Yuan" 3 => "W.S. Rus" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "1989" "volumen" => "125" "paginaInicial" => "655" "paginaFinal" => "659" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2540719" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extragenital bowenoid papulosis associated with atypical human papillomavirus genotypes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A.J. Papadopoulos" 1 => "R.A. Schwartz" 2 => "A. Lefkowitz" 3 => "L.L. Tinkle" 4 => "C.K. Jänniger" 5 => "W.C. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 12 | 6 | 18 |
| 2024 October | 96 | 64 | 160 |
| 2024 September | 100 | 41 | 141 |
| 2024 August | 130 | 51 | 181 |
| 2024 July | 106 | 56 | 162 |
| 2024 June | 143 | 40 | 183 |
| 2024 May | 116 | 38 | 154 |
| 2024 April | 100 | 29 | 129 |
| 2024 March | 117 | 23 | 140 |
| 2024 February | 95 | 45 | 140 |
| 2024 January | 92 | 30 | 122 |
| 2023 December | 83 | 16 | 99 |
| 2023 November | 118 | 33 | 151 |
| 2023 October | 116 | 15 | 131 |
| 2023 September | 113 | 28 | 141 |
| 2023 August | 75 | 31 | 106 |
| 2023 July | 97 | 38 | 135 |
| 2023 June | 83 | 22 | 105 |
| 2023 May | 110 | 32 | 142 |
| 2023 April | 95 | 22 | 117 |
| 2023 March | 67 | 50 | 117 |
| 2023 February | 75 | 22 | 97 |
| 2023 January | 59 | 36 | 95 |
| 2022 December | 83 | 42 | 125 |
| 2022 November | 57 | 28 | 85 |
| 2022 October | 48 | 27 | 75 |
| 2022 September | 45 | 50 | 95 |
| 2022 August | 35 | 19 | 54 |
| 2022 July | 32 | 41 | 73 |
| 2022 June | 32 | 36 | 68 |
| 2022 May | 69 | 40 | 109 |
| 2022 April | 67 | 29 | 96 |
| 2022 March | 67 | 46 | 113 |
| 2022 February | 52 | 31 | 83 |
| 2022 January | 55 | 38 | 93 |
| 2021 December | 34 | 19 | 53 |
| 2021 November | 62 | 54 | 116 |
| 2021 October | 47 | 43 | 90 |
| 2021 September | 39 | 47 | 86 |
| 2021 August | 63 | 29 | 92 |
| 2021 July | 53 | 32 | 85 |
| 2021 June | 51 | 43 | 94 |
| 2021 May | 37 | 28 | 65 |
| 2021 April | 95 | 85 | 180 |
| 2021 March | 58 | 47 | 105 |
| 2021 February | 48 | 25 | 73 |
| 2021 January | 51 | 18 | 69 |
| 2020 December | 31 | 20 | 51 |
| 2020 November | 42 | 21 | 63 |
| 2020 October | 42 | 18 | 60 |
| 2020 September | 32 | 15 | 47 |
| 2020 August | 34 | 18 | 52 |
| 2020 July | 39 | 17 | 56 |
| 2020 June | 63 | 34 | 97 |
| 2020 May | 43 | 25 | 68 |
| 2020 April | 30 | 35 | 65 |
| 2020 March | 35 | 26 | 61 |
| 2020 February | 4 | 16 | 20 |
| 2020 January | 0 | 18 | 18 |
| 2019 December | 0 | 16 | 16 |
| 2019 November | 0 | 18 | 18 |
| 2019 October | 0 | 14 | 14 |
| 2019 September | 0 | 15 | 15 |
| 2019 August | 0 | 9 | 9 |
| 2019 July | 0 | 20 | 20 |
| 2019 June | 0 | 25 | 25 |
| 2019 May | 0 | 18 | 18 |
| 2019 April | 0 | 31 | 31 |
| 2019 March | 0 | 21 | 21 |
| 2019 February | 2 | 13 | 15 |
| 2019 January | 0 | 19 | 19 |
| 2018 December | 2 | 6 | 8 |
| 2018 November | 1 | 3 | 4 |
| 2018 October | 4 | 0 | 4 |
| 2018 September | 4 | 0 | 4 |
| 2018 June | 0 | 2 | 2 |
| 2018 May | 0 | 6 | 6 |
| 2018 April | 0 | 6 | 6 |
| 2018 March | 7 | 2 | 9 |
| 2018 February | 46 | 9 | 55 |
| 2018 January | 42 | 12 | 54 |
| 2017 December | 42 | 9 | 51 |
| 2017 November | 49 | 4 | 53 |
| 2017 October | 59 | 4 | 63 |
| 2017 September | 48 | 11 | 59 |
| 2017 August | 55 | 6 | 61 |
| 2017 July | 33 | 10 | 43 |
| 2017 June | 59 | 15 | 74 |
| 2017 May | 44 | 15 | 59 |
| 2017 April | 31 | 11 | 42 |
| 2017 March | 34 | 10 | 44 |
| 2017 February | 51 | 8 | 59 |
| 2017 January | 34 | 6 | 40 |
| 2016 December | 48 | 17 | 65 |
| 2016 November | 96 | 17 | 113 |
| 2016 October | 104 | 15 | 119 |
| 2016 September | 168 | 11 | 179 |
| 2016 August | 67 | 11 | 78 |
| 2016 July | 39 | 11 | 50 |
| 2016 June | 6 | 11 | 17 |
| 2016 May | 7 | 6 | 13 |
| 2016 April | 5 | 5 | 10 |
| 2016 March | 10 | 3 | 13 |
| 2016 February | 16 | 1 | 17 |
| 2016 January | 5 | 1 | 6 |
| 2015 December | 10 | 0 | 10 |
| 2015 November | 13 | 3 | 16 |
| 2015 October | 8 | 1 | 9 |
| 2015 September | 9 | 3 | 12 |
| 2015 August | 7 | 1 | 8 |
| 2015 July | 46 | 1 | 47 |
| 2015 June | 33 | 11 | 44 |
| 2015 May | 44 | 16 | 60 |
| 2015 April | 35 | 7 | 42 |
| 2015 March | 25 | 8 | 33 |
| 2015 February | 34 | 6 | 40 |
| 2015 January | 50 | 7 | 57 |
| 2014 December | 36 | 5 | 41 |
| 2014 November | 36 | 3 | 39 |
| 2014 October | 40 | 3 | 43 |
| 2014 September | 36 | 1 | 37 |
| 2014 August | 37 | 5 | 42 |
| 2014 July | 36 | 7 | 43 |
| 2014 June | 55 | 6 | 61 |
| 2014 May | 46 | 10 | 56 |
| 2014 April | 35 | 4 | 39 |
| 2014 March | 49 | 7 | 56 |
| 2014 February | 28 | 4 | 32 |
| 2014 January | 25 | 9 | 34 |
| 2013 December | 17 | 4 | 21 |
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