Multiple Pigmented Bowen’s Disease: A Diagnostic and Therapeutic Dilemma

Abstract

Bowens' disease (BD) is a precancerous condition of skin and/or mucosa with a predilection towards sun-exposed areas. Extensive literature research failed to reveal any case of multiple pigmented BD in type V Fitzpatrick skin. Multiple BD is a therapeutic challenge with a tendency to recur. Here we present an otherwise healthy Indian male having multiple pigmented lesions of BD on sun-protected sites of the body mimicking malignant melanoma. These lesions were refractory to treatment with different modalities. This paper is an attempt to review the available literature regarding the pigmented variant of multiple BD. Rationale for a therapeutic trial of UVB therapy for multiple arsenic induced BD is also discussed.

Pigmented Bowen’s disease (Bowenoid Papulosis) dermoscopically mimicking melanoma

“…Sun exposure, gravity, arsenic ingestion, chronic trauma, immunosuppression, irradiation and HPV infection are etiological factors for developing BD. HPV infection is especially an important risk factor for genital BD as well as other non-sun-exposed areas 3,5 . It has been shown that, HPV subtypes 2,16,27,33,34,56,58,59,76 were related with BD.…”

“…HPV infection leads to down regulation of E6 and E7 proteins in the host chromosomes. This issue is responsible for malignant transformation 5 . In our case, high risk HPV subtypes were positive as triggering factor.…”

Photodynamic therapy for dermatologic conditions in the pediatric population: a literature review

“…For SCCis, the literature suggests a clinical clearance rate around 80–100% with ALA‐PDT, and superior cosmetic results compared to cryotherapy or 5‐fluorouracil (5‐FU) . SCCis is rare in children . Hyun et al .…”

“…For SCCis, the literature suggests a clinical clearance rate around 80-100% with ALA-PDT, and superior cosmetic results compared to cryotherapy or 5-fluorouracil (5-FU) (15). SCCis is rare in children (16,17). Hyun et al (18) reported complete clearance of periungual SCCis in a 12-year-old boy who underwent MAL-PDT twice, with no recurrence at nine months.…”

“…(34) reported a mean clearance of 95% after three courses of 5% ALA-PDT to 21 Chinese adolescents(12)(13)(14)(15)(16)(17)(18) year old) with severe acne.Taoet al (35) similarly treated 136 individuals with acne, aged 15-38 (mean 15.38 years), with three sessions of PDT, but used a lower concentration 3.6% topical ALA. The mean effectiveness rate and cure rate of the low-dose ALA-PDT were 92.65% and 47.06%, respectively.…”