Byline: Veeranna. Shastry, Jayadev. Betkerur, Kushalappa.
Bowenoid papulosis is a rare condition of the genital area caused by human papilloma virus. Clinically, it resembles viral wart and histopathologically Bowen's disease. We herein report two male patients presenting with multiple flat papules on the penis and scrotum. The second patient was HIV-positive. Histopathology showed features of bowenoid papulosis. Both the patients were treated with topical tazarotene gel 0.05%. Lesions cleared within 2 weeks in both the patients.Second patient had recurrences that cleared after retreatment with tazarotene.
Bowenoid papulosis (BP) is a distinct clinicopathologic entity characterized by multiple, small skin colored to reddish brown papules, primarily occurring on the genitalia of young adults. BP is strongly associated with human papilloma virus (HPV) infection and is difficult to differentiate clinically and histopathologically from squamous cell carcinoma in situ .[sup]  It is often considered as low grade in situ carcinoma.[sup] 
We herein report two cases of BP of genitalia successfully treated with topical tazarotene.
A 31-year-old, unmarried male presented with asymptomatic lesions over the scrotum for the past one year. Earlier treatment with topical steroids and antifungal agents had not shown any improvement. On examination, there was a large, well-defined, pigmented plaque with velvety surface over the scrotum [Figure 1]a. There were similar smaller papules present on the adjacent area and over the prepuce. Blood VDRL and HIV screening test were nonreactive. Skin biopsy from the lesion over the scrotum showed irregular acanthosis, disordered maturation of the epidermis, crowding of the nuclei, focal hypergranulosis, dyskeratosis, hyperchromatic, and multinucleated keratinocytes with increased mitosis [Figure 2] and [Figure 3].
On the basis of the clinical and histological features, the case was diagnosed as bowenoid papulosis and the patient was treated with tazarotene gel 0.05% once daily. After one week, lesion became erythematous and scaly with mild irritation and the treatment was stopped. The lesions completely cleared in the next week [Figure 1]b. The patient is under follow up for one year and there is no relapse.