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Dr. Arun Phophalia, Doctor (MD)
Category: Health
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Experience: MBBS, MS (General Surgery), Fellowship in Sports Medicine
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is bowens disease systematic, or can other lesions on the

Resolved Question:

is bowen's disease systematic, or can other lesions on the body simply be psoraisis?

Submitted: 10 months ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 10 months ago.

Greetings.

Bowen disease in majority of instances appear with a single lesion on the body. So your other lesions are not likely to be Bowen disease. Though a biopsy of the other lesion is mandatory to pin point the cause. This can be co-incidence of appearance of Bowen disease and other lesion like psoriasis simultaneously or just in small duration apart. Apart from psoriasis; other causes which mimic Bowen disease are actinic keratitis and lichen simplex chronicus.

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

 

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Customer: replied 10 months ago.

I have found NIH results that told me that if I have Bowen's Disease confirmed, I could not have psoriasis at the same time...it would be more Bowen's manifesting in another part of the body that would look like psoriasis, but would by necessity be lumped in the the Bowen's Disease family.

I am trying to stop the other areas from spreading and the meds are clobex for the scaly parts and 5FU for areas on my chest and face.

I can not find a single resource showing Bowen's and psoriasis happening at the same time, let alone all developing at the same time...all during when I noticed the lump on my chest and when the biopsied it. What would i have to do, biopsy all of them individually?

That is why I asked (out of rare diseases) could this just be acting rarely and all of the issues related?

Thank you!

Gene

Expert:  Dr. Arun Phophalia replied 10 months ago.

You are very welcome, Gene.

Not all of them have to be biopsied. Only 2-3 have to be biopsied, which will confirm the cause.

Bowen disease may occur due to low body immunity or exposure to actinic rays of sun. Actinic keratitis also occurs due to sun; so other lesions may be related.

Just an interesting study for your reference;

Bowen's disease of the umbilicus simulating psoriasis vulgaris.Kolbusz RV, Fretzin DF.

Source

Department of Pathology, Michael Reese Hospital & Medical Center, Chicago, Illinois 60616.

Abstract

Bowen's disease and other primary cutaneous malignancies are uncommon in patients with psoriasis. Primary malignancies of the umbilicus are also unusual. Plaques of psoriasis and Bowen's disease may appear morphologically similar, requiring examination of a biopsy specimen for definitive diagnosis. We report on a patient with psoriasis who experienced Bowen's disease of the umbilicus that was initially believed to be psoriasis.

http://www.ncbi.nlm.nih.gov/pubmed/3234030

 

It is privilege assisting you.

 

Expert:  Dr. Arun Phophalia replied 10 months ago.

Just an interesting reference for you, Gene.

Proc R Soc Med. 1932 May; 25(7): 1033–1034. PMCID: PMC2183776Bowen's Disease with Prickle-celled Carcinoma and associated with PsoriasisW. N. Goldsmith Copyright and License information ►

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2183776/

Customer: replied 10 months ago.

Hello Dr. Arun,


I guess I still don't feel like I have what I am looking for yet. I still am wondering if the Bowen's Disease is systematic.

I may be asking this wrong, but basically want to know if it is 'IN' me, or just 'ON' me until it is removed? I think from what I have read, that is a disease I now have confirmed that will not go away, but the issues caused by it can be treated.

Therefore, since I have tested positive for having this disease by looking at my hair follicle, are all of these other skin conditions related, or did they just happen to all come from nowhere at the same time.

I really hope I am conveying myself correctly here, as the most important factor I have read is to stop of slow its progress. And if I am getting differing explanations as to this is BD, this is psoriasis, this is unknown oral lesions, etc...how am I suppose to pull myself together to fight one battle? Of should I consider myself not at risk and fight the 5 separate battles that coincidentally appeared at the same time?

Sorry for taking up so much time, but my dermatologist just ran in scraped, burned, and said the rest is psoriasis and left. And after reading all of the problems people with BD can have over the long-term, and me being 41, I am seriously concerned about this being something I can not take care of by myself.

Thanks again, and please any information about how the disease is stored in my body and when/where is may rear its hear are really what would be most useful now.

Cheers,

Gene

Expert:  Dr. Arun Phophalia replied 10 months ago.

Hello Gene,

Your major concerns are;

1) Are all the lesions Bowen disease? Biopsy of any of two would be able to confirm it. Not all of them have to be biopsied.

2) If all are Bowen disease; you need the local treatment or systemic treatment (to eradicate it from the root)? It would need local treatment and systemic treatment would not be needed as it is not a systemic disease. The appearance of the lesions simultaneously is a co-incidence. Once the present lesions are treated, recurrence on the same sites or elsewhere on the body is not very likely.

Bowen disease is caused by;
1) Chronic UV radiation: chronic sun damage.

2) Arsenic exposure

3) Human papillomavirus (HPV)

4) Genetic factors,

5) Other chemical carcinogens,

6) X-ray radiation.

The most of causative affect the skin; so it would not be considered as systemic disease. It affects specific skin cell called keratinocytes.

You perhaps are worried that if it keep on recurring in future, there are some inherent factors which are causing it. Most of the factors are skin related (except the genetic factor).

This further recurrence can be prevented by;

1) Increasing body resistance
2) Using Sun screens
3) Photoprotective clothes.

Customer: replied 10 months ago.

Hello again Dr. Arun,


From your list above I am detailing what I have/had below:


1) Chronic UV radiation: chronic sun damage.
I have been told I have chronic sun damage.
2) Arsenic exposure
Not that I know.
3) Human papillomavirus (HPV)
I have had anal HPV surgically removed 10 years ago
4) Genetic factors,
My mother has BD on her face and neck
5) Other chemical carcinogens,
I have been on a series of medications relating to my diagnosis with Ankyclosing Spondylitis (AS)
6) X-ray radiation.

I have had many back surgeries, eventually culminating in total disc replacement of my L4-L5 and L5-S1 vertabrae. I have Maverick metal replacement disc on both levels.


Perhaps I should have lead off with all of that history, but I guess that is why I am quite concerned about another drawn-out battle. I am now at a point in my life where the AS is not impacting me beyond stiffness upon beginning movement, which goes away as I move more, to the point of being able to play competitive volleyball, yet barely able to get up to use the restroom in the middle of the night.


I have been doing all of your prevention measures since having some small (unbiopsied) pre-cancer over a year ago.


I have read in a British medical guide online, intended for those with advanced knowledge, that psoriasis is not found in people with Bowen's disease.


Would the symptoms of BD be treated the same as psoriasis, regardless of the cause? I am really concerned that since my dermatologist was not worried about it, and did not ask for any further explanations on my medical questionnaire, that I may have more going on than simply what he observed, but didn't test. Do you have any suggestions on how to address my concerns more appropriately?


I really do appreciate all of the information you have provided, but I think you just hit the nail on the head! Are there different ways to approach treatment if it is more systematic?


Thank you very much!

Gene

Expert:  Dr. Arun Phophalia replied 10 months ago.

You are very welcome, Gene.

Your dermatologist should have taken a detailed history and also considered the biopsy for the confirmation of other lesions. Bowen and psoriasis have different modality of treatment. And Bowen which has multiple lesions is treated in same way as a solitary lesion.

Dr. Arun Phophalia, Doctor (MD)
Category: Health
Positive Feedback: 98.6 %
Satisfied Customers: 28117
Experience: MBBS, MS (General Surgery), Fellowship in Sports Medicine
Dr. Arun Phophalia and 6 other Health Specialists are ready to help you
Customer: replied 10 months ago.

Thank you very much Dr Arun!


 


I have the conversation going with my dermatoligist now!


 


I really appreciate your guidance on this and I will continue my follow up with my Primary Care Physician and my Dermatologist!


 


Bests to You!!!


 


Thanks again,


Gene

Expert:  Dr. Arun Phophalia replied 10 months ago.

You are very welcome, Gene.

Thanks for your kind words.

I would be grateful, if you rate our conversation as excellent.

Thank you.

My best wishes,

Dr. Arun

Customer: replied 10 months ago.

I did click on 'EXCELLENT SERVICE' :)


 


It took me to a page saying I was not logged in, so please let me know if i need to contact Just Answer to tell them I was getting an error message.


 


Also, I wanted to give you a great response and tip, but it just took me to the error page.


 


Either way, I would love to recommend you to friends, is there a way for me to refer you on justanswer.com or another way to get your advise?


 


Cheers,


gene

Expert:  Dr. Arun Phophalia replied 10 months ago.

Thanks Gene, for all the time taken and your kind responses.

Please contact the site administration, if you can. I am also informing them about the error message. Though the excellent service rating has been recorded. I appreciate it.

This is my profile page link, where you and friends can ask me question directly, by posting question in the box. It gives me a lock of 15 minutes.

http://www.justanswer.com/medical/expert-drarunphophalia/


The other way to ask question is to start the question as, "For Dr. Arun only."

Cheers,

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