What is Bowenoid Papulosis?

Bowenoid papulosis is a skin condition that is characterized by papules that appear on male genitalia. Well, that was the original belief of bowenoid papulosis. Nowadays, it is known to occur on the genitalia of both male and females individuals who are sexually active and do not use protective measures. These papules are believed to be benign and harmless, but there is a small chance that the lesions will develop into a malignant skin condition.

This condition is spread virally; it can be transmitted sexually or contracted from sharing undergarments; the causative agent is the human papilloma virus (HPV); the family of HPV is well known for its persistence and its recurrence. Although the lesions are at first asymptomatic, they can be painful, itchy, or inflamed. The condition does not favor any race.

As a piece of advice, a condom or any barrier method should be used to stop the spread of the condition. And furthermore, it is advised to not borrow undergarments or let others borrow your undergarments, for one may not know if a person may be an innocent victim of the disease.

Bowenoid Populosis on male genitalia

Sign and Symptoms of Bowenoid Papulosis

Lesions primarily appear on the genital area of a patient (male and female) who has bowenoid papulosis. The appearance of the lesions is similar to genital warts, probably due to the same causative agent. The papules can be small and brown or red in colour, and flat or elevated, They appear on the shaft of the penis in male patients and on the labial folds in female patients. They can also appear on the area around the anus. The condition can start like normal, harmless lesions due to the absence of pain, but the lesions, after some time, can become painful, itchy, and inflamed.

Bowenoid Populosis Pictures

Bowenoid papulosis on perianal area

Bowenoid papulosis on penile area

Causes and Risk Factors of Bowenoid Papulosis

The causative agent of bowenoid papulosis is HPV, which is the same causative agent of genital warts. It is also categorized as a sexually transmitted disease (STD) because it can be acquired through sexual contact. There are some cases when it can be passed down from mother-to-child during birth, so even in the early life of a child, it can be present, and the symptoms can be felt by the child.

The risk factors can vary; the condition can affect even a baby if the mother is affected as well. Sexually active teenagers and young adults are also predisposed to the condition especially if they do not practice safe sex with multiple partners.

Diagnosis of Bowenoid Papulosis

Like any other skin conditions, the method to diagnose the condition is to perform a skin biopsy. This is a definitive approach to determine the composition and nature of the lesion and to differentiate bowenoid papulosis from other similar skin conditions that are caused by HPV such as genital herpes or genital warts.

A skin biopsy can also be curative since  the treatment of  bowenoid papulosis involves the destruction of the lesions which should be made with sanitary precautions to prevent the spread of the disease.

Treatment of Bowenoid Papulosis

Treatment is mostly superficial. A simple, clean and sanitized destruction of the lesions will do the job, but then again, I will emphasize the use of sanitary precautions to avoid re-infection and the spread of the infection. Retinoids can also help heal the lesions as these chemicals have been proven to be effective against abnormal skin conditions.

There can be a surgical intervention for bowenoid papulosis. But even though we can perform surgery to treat the condition, it is not a practical choice because bowenoid papulosis and other HPV-induced skin conditions are well-known for their high recurrence. There are other methods  to try, but then again, HPV is a persistent virus which can recur any time after those treatment methods. The best thing to do is to stick with a treatment modality that is affordable and inexpensive.

Prognosis of Bowenoid Papulosis

According to the most recent studies, the prognosis varies from person to person. Studies have shown that younger patients who have bowenoid papulosis can have a self-limiting condition which may only last for months; however, in patients who are older, it can last for years. And in cases of patients who are immunocompromised (people with a low immune system), they tend to experience a longer period of the condition which may be impossible to be resolved.

What is Exercise-Induced Asthma?

Exercise-Induced asthma (EIA) is a medical disorder that happens when a person’s airways becomes narrow due to exercise. Experts would use the term called exercise-induced bronchoconstriction (EIB). For the record, exercise does not result in asthma, but it can trigger asthmatic attacks.

Asthma, which is a lung disorder, is a medical condition that is characterized by bronchi inflammation and sudden, severe attacks which may or may not cause symptoms. When a person is exposed to one of his or her triggering factors, the inflammation worsens, causing tightened airways and excess mucus production. People who have this disease condition will tend to experience asthma during prolonged or vigorous physical exertion or exercise. Furthermore, these people will experience three classic signs, airway inflammation, excess mucus production, and bronchoconstriction.

Exercise-Induced Asthma Symptoms

People who have EIA attacks have sensitive muscles bands which surround the airways. Sensitive to humidity and temperature changes, these airways constrict and narrow. Other symptoms include the following:

• Shortness of breath
• Wheezing
• Chest tightening
• Unusual fatigue during exercise
• Coughing
• Pooir athletic performance
• Elevated respiratory rate
• Cyanosis (bluish coloration of the skin)

What Causes Exercise-Induced Asthma?

Asthma can either be hereditary or congenital. However, it is not clear what causes EIA in some people. Individuals who are susceptible to EIA have triggering symptoms from heavy breathing episodes which cause cooling or drying of the airways. The factors that can worsen or trigger EIA are as follows:

• Dry air
• Cold air
• Chemical exposure
• Respiratory infection
• High pollen count
• Exposure to air pollution

Usually EIA only happens in activities which demand increased breathing. Such activities include running, aerobic exercise, playing hockey, soccer, and basketball. Furthermore, people who exercise in cold weather will also be susceptible to an increased risk of asthma symptoms.

Exercise-Induced Asthma Diagnosis

Because this condition happens most often when a person has been exercising vigorously, most often people will misinterpret this kind of condition as a normal reaction. Hence, EIA can be hard to diagnose, clinically speaking. Results from only the physical examination and medical history exam will not provide an accurate medical picture. Hence, other diagnostic tests are given to confirm whether or not a person truly has EIA, including:

• Treadmill exam

This exam, which uses ergometer-based or treadmill testing to examine the function of the lungs, is an effective diagnosis exam for EIA, but there might also be a tendency to create a false negative.

• Field exercise exam

This exam assesses the athlete after he or she performs the given exercise. In the case of EIA, the test will normally exhibit an eucapnic voluntary hyperventilation which is considered to be the less sensitive type.

• Objective exam

This exam begins with the use of spirometry before and after taking a inhaled bronchodilator. This type of exam will determine if the person has an abnormal baseline lung function, which possibly requires maintenance treatment. Yet, this exam should not be the only confirmatory diagnostic test since it is an inadequate diagnosis test for EIA.

• Test involving mannitol inhalation
  

It is a new test that has the ability to document EIA.

• Pharmacological challenge exam

An example of this exam is the methacholine challenge test which is known to provide a lower sensitivity for detection of EIA.

• Peak flow measurement

This is a lung function test that determine the work of the lungs. This is a handheld small device which is used to measure the speed of the forced air that goes out of the lungs. When a person has a slow exhalation due to bronchoconstriction, it is sign that the person has a worsened asthma condition.

• Allergy skin exam

In this exam, there is a need to prick the person’s skin with a purified form of an allergy extract. After pricking, the area will be observed for any signs of an allergic reaction. This exam helps to pinpoint the type of allergies, such as animal dander, dust mites, latex, and mold.

Exercise-Induced Asthma Treatment

There are two ways to treat EIA:

Pharmacological treatment

This deals with drug prescriptions that are used to relieve bronchoconstriction encountered during EIA attacks. The drugs which are prescribed are those that belong to the drug classification called bronchodilator. These bronchodilator drugs are also subdivided into two categories:

Quick relief bronchodilators

These are well known as rescue medications which act as a short-term, quick relief from symptoms during EIA. It is recommended to take these medications prior to exercising. They are also further classified into the following:

• Ipratropium
• Short-acting beta-agonists
• Long relief bronchodilators

The second kind of medication, which is taken on a day-to-day basis, can be further classified into the following:

• Theophylline
• Leukotriene modifiers
• Inhaled corticosteroids
• Combinations inhalers
• Long-acting beta-agonists

Other effective medications include:

• Immunotherapy
• Allergic medications
• Omalizumab

Non-Pharmacological treatment

Besides prescribed medications, another way of treating EIA is through non-pharmacological ways which can be done through:

Selection of suitable sports

This will guide and prevent the athlete from experiencing bronchospasm. The athlete is given a choice when and where to do his or her activities. He or she can opt to do his or her activities in a place where the air is warmer and humidified.

Warm-up modifications and breathing techniques

Altering warm-up or breathing techniques may be done; for example altering from the mouth-breathing to nasal-breathing exercises creates a lesser form of bronchospasm and increases the performance.

With such treatments, EIA attacks can be prevented in the nearby future, and the day-to-day life can be managed without interruptions or disturbances.