Bowenoid papulosis of the genital area

　　One, Etiology

　　Bowenoid papulosis of the genital area may be related to the following viral infections:

　　1, Related to HPV infection:Gross (1985) reported that a specific DNA sequence closely related to HPV was found in the lesions of Bowenoid papulosis, proving that this viral infection plays a certain role in the pathogenesis of Bowenoid papulosis, and 63% of genital Bowenoid papulosis were detected with HPV16. Crook (1991) reported that the carcinogenicity of HPV16 is the binding of the E6 and E7 proteins encoded by the virus to the tumor suppressor protein p53 of the host cell, inactivating the tumor suppressor protein, which is a key step in the development of various cancers. Yamashita (2000) and others showed by polymerase chain reaction that HPV31 and 67 are high-risk factors for the malignant transformation of Bowenoid papulosis into squamous cell carcinoma.

　　2, Related to HIV (human immunodeficiency virus) infection:Brodland pointed out that a group of skin and mucosal tumors including basal cell carcinoma, squamous cell carcinoma, and Bowenoid papulosis are related to the onset of AIDS.

　　3, May be related to HSV (herpes simplex virus):Simplex virus type 2-induced antigens are often found in the cells of Bowenoid papulosis in the labia area.

　　Two, Pathogenesis

　　The Bowenoid papulosis of the genital area is histologically similar to Bowen's disease, but not completely identical. Under the microscope, the keratin layer of the epidermis shows incomplete keratinization, hyperplasia of the prickle layer, some atypical hyperplasia of cells, uneven cell size, and increased nuclear-cytoplasmic ratio. The nuclei are irregularly aggregated, showing a 'wind-blown' change, with active mitosis and the appearance of clusters of mitotic figures, abnormal nuclei, or multinucleated nuclei. There are a few cavitated cells in the superficial layer, with the base of the nail extending and widening, and the dermal capillaries dilated with lymphocytic infiltration.

　　Bowenoid papulosis of the genital area is a multiple flat papule occurring on the external genitalia of young people, with histopathology showing low-grade malignant squamous epithelial in situ carcinoma. Since Bowenoid papulosis often coexists with HPV (human papillomavirus) infection, the disease has now been classified as a sexually transmitted disease. Common complications include infections of the vulva and vagina with other bacteria.

　　Bowenoid papulosis of the genital area is more common in female external genitalia and labia, male glans and penis. The lesions are often multiple, slightly protuberant papules on the skin, ranging from brownish-red to purple, with some scales. Severe cases may merge into patchy lesions. Some skin lesions may appear velvety or warty, without ulceration. Female external genitalia and perianal areas may have pink or brownish-red papules or warts, with a diameter of 0.2 to 1.0 cm, averaging 4 mm, often coexisting with condyloma acuminatum, small in lesion size, without ulcers, scabs, not infiltrating subcutaneous tissue. Some cases can naturally improve or regress within 3 months to 1 year, and some literature reports suggest that it can also undergo malignant transformation.

　　Prevention of Bowenoid papulosis of the genital area should focus on strengthening the physique, maintaining good hygiene, preventing reproductive tract viral infection, regular physical examination, early detection, early treatment, and doing a good follow-up job.

　　Prognosis:Generally benign lesions, can recur, often coexist with condyloma acuminatum, small in lesion size, without ulcers, scabs, not infiltrating subcutaneous tissue. Some cases can naturally improve or regress within 3 months to 1 year. However, there is a 2.6% malignancy rate.

　　Patients with Bowenoid papulosis of the genital area need to undergo immunological tests; polymerase chain reaction for human papillomavirus, polymerase chain reaction for herpes simplex virus, and other tests. Colposcopy examination, tissue pathology examination.

　　One, Dietetic recipe for Bowenoid papulosis of the genital area

　　1, Use equal amounts of mung bean and coix seed. First, boil the mung bean in water, cook for a moment after it boils, then add the coix seed to cook into porridge. Eat it every night before going to bed.

　　2, Take 50 grams of coix seed. Boil it to make porridge, add 15 grams of sugar, and eat it. Take 1 to 2 times a day. It can be eaten for a long time.

　　3, Take 10 grams each of mulberry leaves, chrysanthemum, forsythia, mint, cinnamon twigs, almonds, sower seed, raw earth, figwort, cicada shell, and silver flower, and 5 grams of grass. Take one dose per day, decocted and taken twice a day. For those with long-standing illness, use 30 grams of raw oyster shell, 15 grams each of Danshen, Spatholobus suberectus, figwort, and 10 grams each of Angelica sinensis, safflower, purple草根, red peony root, Chuanxiong, white thorn, trigonella, and ophiopogon. Take one dose per day, decocted and taken twice a day.

　　4, Seaweed Coix Seed Porridge: 10 grams of seaweed, 10 grams of kelp, 10 grams of sweet almond, 15 grams of mugwort root, 50 grams of coix seed. Add the first four herbs to 950 milliliters of water, decoct to 500 milliliters of juice, then cook the coix seed with the juice to make porridge. It can be eaten once a day, for a total of 20 doses.

　　5. Chuanzi Coix Seed Porridge: 10 grams of Chuanzi, 10 grams of wood, 15 grams of silver flower, 50 grams of Coix Seed, and appropriate amount of sugar. Add Chuanzi, wood, and silver flower to 750 milliliters of water, decoct to 500 milliliters of juice, then cook with Coix Seed to make porridge, and add sugar when it is cooked. Take it once a day.

　　Second, what foods are good for the body with vulvar Bowenoid papulosis

　　1. Maintain a light diet, eat more fresh vegetables and fruits.

　　2. Eat more cooling foods, such as mung beans and Job's tears, for clearing heat and detoxification.

　　Third, what foods should not be eaten for vulvar Bowenoid papulosis

　　1. Avoid animal protein foods and seafood, such as shrimps, crabs, etc. Otherwise, it will worsen the degree of itching.

　　2. Avoid stimulants such as coffee.

　　3. Avoid spicy and刺激性 foods such as scallions, garlic, ginger, and cinnamon.

　　4. Avoid greasy, fried, moldy, and salted foods.

　　(The above information is for reference only, please consult a doctor for details.)

　　First, surgical treatment:If the area of the skin lesions is large but the number is small, surgical resection can be adopted.

　　Second, drug treatment:Topical medication, topical application of 5-Fu ointment, 3 weeks as one course, some skin lesions may become red and swollen, eroded, and the symptoms disappear after discontinuation of medication, and the skin lesions regress.

　　Third, other special therapies

　　1. In the case of excluding vulvar invasive cancer through biopsy, carbon dioxide laser treatment can be used, with good effects.

　　2. Liquid nitrogen freezing.

　　3. Wigbels et al. reported that imiquimod cream, an immunosuppressant, is a safe, effective, and practical treatment method for Bowenoid papulosis.

　　The above methods can also be used simultaneously to treat Bowenoid papulosis, such as combined use of surgical resection and laser treatment, and combined treatment of surgical resection with topical 5-Fu ointment. Since vulvar Bowenoid papulosis often accompanies HPV infection, and the latter has the potential for malignancy, patients with vulvar Bowenoid papulosis and their sexual partners should be followed up for a long time. The most common treatment is local resection combined with local 5-Fu. ISSVD recommends no longer using Bowenoid papulosis. Lesions are sent for biopsy, and curettage or laser treatment can be performed after diagnosis.