Case and Research Letters
Linear Bowenoid Papulosis
Papulosis bowenoide lineal
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A, Sclerotic dermis with dense collagen and a scar-like appearance (original magnification ×10). B, Detail of a broken hair follicle (original magnification ×40). C, Peripheral multinucleated giant cells (original magnification ×40).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "E. Macías del Toro, M.A. González Domingo, F. Alfageme Roldán" "autores" => array:3 [ 0 => array:2 [ "nombre" => "E." "apellidos" => "Macías del Toro" ] 1 => array:2 [ "nombre" => "M.A." "apellidos" => "González Domingo" ] 2 => array:2 [ "nombre" => "F." 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Similar to Bowen disease, histopathology reveals squamous cell carcinoma in situ.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> While the term bowenoid papulosis is not included in the 2016 World Health Organization classification of tumors of the penis,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> the clinical and epidemiological characteristics of the disease and its favorable prognosis lead dermatologists to continue to use the classic nomenclature and consider this condition a differential entity.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Bowenoid papulosis usually manifests as a polygonal planar papular rash on the genital-anal region; however, it may often take on multiple morphologies that should be borne in mind by the physician. We report a case of bowenoid papulosis with an unusual clinical presentation.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient was an otherwise healthy 46-year-old uncircumcised man who consulted for a linear lesion on the penis that had first appeared a few weeks previously. He complained of mild pruritus and denied sexual relations outside his habitual partner or injuries in the area. He also denied dysuria or urethral secretion. Physical examination revealed a raised linear lesion that ran parallel to the coronal sulcus along almost all its circumference. It was 1−2<span class="elsevierStyleHsp" style=""></span>mm wide and erythematous-violaceous in color. The lesion was continuous and seemed to be formed by coalescent papules (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). There were no additional lesions in the genital-anal or oral areas or palpable enlarged lymph nodes. Biopsy revealed an irregularly acanthotic epidermis with hyperkeratosis, parakeratosis, and increased cellularity from the basal layer to the surface, with loss of maturation in all its thickness. The cells were large, occasionally multinucleated, with hyperchromatic nuclei and mitosis in the upper layers of the epidermis (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). p16 immunohistochemistry revealed intense and diffuse nuclear positivity throughout the thickness of the epidermis (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Serology testing for syphilis, hepatitis B and C virus, and human immunodeficiency virus was negative.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The patient was offered various options for therapy and chose a more conservative approach. After receiving the patient’s consent, we decided to apply topical treatment with sinecatechins 10 % ointment tid. The lesion disappeared completely in 6 weeks, and tolerance of treatment was excellent.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Bowenoid papulosis usually affects young, generally sexually active people between the third and fourth decades of life. The clinical manifestations are polymorphous and comprise macules, papules, and plaques with a flat surface. These are dome-shaped, papillomatous, or verrucous and generally multifocal. While they are frequently pigmented, they may also be erythematous, violaceous, flesh-colored, or leukoplastic.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3–5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Clinical presentation in the form of linear lesions is very unusual. Our review yielded only 7 cases,<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,5–8</span></a> thus making the present case the eighth to date. Seven patients were men and only 1 was a woman.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> In men, the lesion tended to affect the coronal sulcus or adjacent area and was circumferential.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,6,7</span></a> Since the lesions usually take the form of coalescent individual lesions, the linear configuration may be continuous or intermittent, with the result that isolated papules are also frequently found close to the linear lesion.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> The case we report is almost identical to that reported by Sweidan et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> in the sense that it involves a single linear, almost filiform lesion in the area of the coronal sulcus with no satellite lesions, thus potentially facilitating the clinical diagnosis.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The mechanism underlying this presentation of bowenoid papulosis is unknown, although it is thought to be associated with a Koebner phenomenon.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Thus, it has been speculated that, since most of these lesions appear close to the coronal sulcus, HPV in the area may be more difficult to eliminate, possibly for anatomical reasons. Therefore, its prolonged persistence in the area could favor this presentation.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Treatment of linear bowenoid papulosis is the same as that of classic disease, which can persist, remit, or recur. Treatment is generally destructive and may comprise conventional surgery, electrocautery, cryotherapy, imiquimod, topical 5-fluorouracil, podophyllin, podophyllotoxin, CO<span class="elsevierStyleInf">2</span> laser therapy, and photodynamic therapy.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Sinecatechins ointment is a standard extract of green tea leaves, which contain a mix of polyphenols with antioxidant, immunostimulatory, antitumor, and antiproliferative properties. It is indicated for genital warts in patients aged ><span class="elsevierStyleHsp" style=""></span>18 years.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Nonetheless, it is curious that, despite the clear involvement of HPV in the etiology and pathogenesis of bowenoid papulosis, we were able to find only 1 patient treated with this approach.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> The ointment was successful and very well tolerated in the case we report, as in the abovementioned case.</p><p id="par0050" class="elsevierStylePara elsevierViewall">While we cannot rule out the possibility of spontaneous resolution, which is well documented in bowenoid papulosis, we believe that the treatment we recommended should become standard in this indication.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-02-20" "fechaAceptado" => "2018-05-15" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Allegue F, Fachal C, González-Vilas D, Zulaica A. Papulosis bowenoide lineal. Actas Dermosifiliogr. 2020;111:76–77.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1203 "Ancho" => 905 "Tamanyo" => 166252 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0165" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythematous-violaceous linear lesion around the penis.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 682 "Ancho" => 905 "Tamanyo" => 190988 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0170" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Epidermis with irregular acanthosis, hyperkeratosis, hypergranulosis, and squamous cells. Dyskeratosis, hyperchromatic nuclei, and multiple nuclei can be observed. Cellular atypia is observed throughout the thickness of the epidermis (hematoxylin-eosin, original magnification, ×200).</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 682 "Ancho" => 905 "Tamanyo" => 262251 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0175" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">p16 immunohistochemistry yields intensely positive results in the cytoplasm and nuclei of keratinocytes throughout the thickness of the epidermis (p16 immunohistochemistry, ×200).</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" => "Bowenoid papulosis in a linear distribution" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "W.S. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 14 | 6 | 20 |
| 2024 October | 158 | 54 | 212 |
| 2024 September | 197 | 29 | 226 |
| 2024 August | 146 | 51 | 197 |
| 2024 July | 131 | 32 | 163 |
| 2024 June | 127 | 41 | 168 |
| 2024 May | 123 | 33 | 156 |
| 2024 April | 122 | 19 | 141 |
| 2024 March | 152 | 26 | 178 |
| 2024 February | 154 | 30 | 184 |
| 2024 January | 140 | 45 | 185 |
| 2023 December | 418 | 23 | 441 |
| 2023 November | 333 | 33 | 366 |
| 2023 October | 244 | 51 | 295 |
| 2023 September | 107 | 67 | 174 |
| 2023 August | 73 | 38 | 111 |
| 2023 July | 117 | 64 | 181 |
| 2023 June | 85 | 77 | 162 |
| 2023 May | 124 | 97 | 221 |
| 2023 April | 90 | 43 | 133 |
| 2023 March | 112 | 64 | 176 |
| 2023 February | 82 | 37 | 119 |
| 2023 January | 86 | 37 | 123 |
| 2022 December | 94 | 49 | 143 |
| 2022 November | 111 | 67 | 178 |
| 2022 October | 67 | 62 | 129 |
| 2022 September | 61 | 63 | 124 |
| 2022 August | 54 | 54 | 108 |
| 2022 July | 63 | 56 | 119 |
| 2022 June | 44 | 48 | 92 |
| 2022 May | 79 | 46 | 125 |
| 2022 April | 73 | 50 | 123 |
| 2022 March | 102 | 55 | 157 |
| 2022 February | 99 | 23 | 122 |
| 2022 January | 93 | 62 | 155 |
| 2021 December | 73 | 42 | 115 |
| 2021 November | 72 | 52 | 124 |
| 2021 October | 85 | 58 | 143 |
| 2021 September | 75 | 45 | 120 |
| 2021 August | 97 | 35 | 132 |
| 2021 July | 83 | 32 | 115 |
| 2021 June | 65 | 41 | 106 |
| 2021 May | 64 | 46 | 110 |
| 2021 April | 194 | 44 | 238 |
| 2021 March | 179 | 38 | 217 |
| 2021 February | 94 | 30 | 124 |
| 2021 January | 81 | 20 | 101 |
| 2020 December | 64 | 19 | 83 |
| 2020 November | 70 | 12 | 82 |
| 2020 October | 59 | 10 | 69 |
| 2020 September | 67 | 24 | 91 |
| 2020 August | 49 | 24 | 73 |
| 2020 July | 53 | 20 | 73 |
| 2020 June | 35 | 16 | 51 |
| 2020 May | 22 | 12 | 34 |
| 2020 April | 35 | 17 | 52 |
| 2020 March | 22 | 9 | 31 |
| 2020 February | 1 | 0 | 1 |
| 2020 January | 1 | 0 | 1 |
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