Bowenoid papulosis at the site of prior herpes progenitalis

A 35-year-old dentist came to the authors' attention for papular and vegetating lesions that had appeared on his penile shaft over the last 2 months. The lesions differed in their features: pink and vegetating on the left side, brown and papular on the right side (Figure 1). The obvious clinical diagnoses of genital warts on the left and Bowenoid papulosis on the right were confirmed by punch biopsies, which showed epithelial hyperplasia with diffuse cell vacuolization (koilocytes)in the left biopsy and moderate nuclear dysplasia in the right one (Figure 2). Human papillomavirus phenotyping was not performed. Interestingly, the patient reported a clear medical history of herpes progenital is (only one episode) that had involved the right side of his glans and prepuce 4 years ago. An immunomodulating treatment with imiquimod was started in the attempt to cure both the genital warts and Bowenoid papulosis lesions (imiquimod was applied three times a week for 8 weeks). At the end of the treatment, the genital warts had disappeared, whereas many Bowenoid papulosis lesions were still present on the right side of the penis (Figure 3). Treated with liquid nitrogen as well, the Bowenoid papulosis lesions disappeared.