At a Glance - Bowen's disease vs contact dermatitis

Contributed by Dr Jean Watkins, a retired GP in Hampshire

Bowen's disease presents with scaly erythematous plaque
Bowen's disease presents with scaly erythematous plaque

BOWEN'S DISEASE
Clinical features

  • In situ, intraepidermal squamous cell carcinoma.
  • Associated with sun exposure, radiotherapy, carcinogens, immunosuppression and HPV-16.
  • Small risk of progression to invasive cancer. Many have had or will develop basal cell carcinoma.
  • More common in women and those over 60 years. The lower leg is a common site.
  • Presents with slow growing, scaly erythematous plaque with irregular borders. Usually a single lesion but can be multiple.

Management

  • Diagnosis confirmed by biopsy.
  • Treatment depends on lesion age, site, size and thickness.
  • 5-fluorouracil has a good cure record.
  • Topical imiquimod, which has both anti-HPV and anti-tumour effects.
  • Cryotherapy can be used but may cause ulceration. The failure rate is 5-10 per cent.
  • Photodynamic therapy is particularly useful for patients with multiple lesions.
  • Radiotherapy.
  • Excision leads to low recurrence, but site of lesion may be a contraindication.

CONTACT DERMATITIS
dermatitis
Clinical features

  • An eczematous response to an allergen or external irritant agent.
  • Common allergens are nickel, chromate topical antibiotics, perfumes, rubber accelerators and preservative chemicals.
  • Irritants include detergents, soaps, acids, alkalis, powders, dust or low humidity. T-cell mediated immune response is not involved.
  • Photo-induced allergic or toxic reactions can cause eczematous reaction.
  • Accounts for 4-7 per cent of dermatological consultations.
  • Presents with itchy erythema, vesiculation, dryness, lichenification and fissures.
  • Area may be well demarcated and limited to contact area.
  • Risk of secondary infection.

Management

  • Patch testing for persistent, unresponsive eczema where allergy a possibility.
  • Avoidance of irritant or allergenic substances.
  • Protect hands with cotton lined or polyvinyl gloves.
  • Frequent use of emollients and soap substitutes.
  • Topical steroid ointments.
  • Other available treatments for steroid-resistant problems are tacrolimus, psoralen and UVA light treatment, azathioprine and ciclosporin.

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Follow Us:

Just published

Submit your session ideas for the RCGP Annual Conference 2019

Submit your session ideas for the RCGP Annual Conference 2019

GPs can now submit ideas for sessions at the RCGP Annual Conference in Liverpool,...

Scottish GP workforce increases for first time in 10 years, figures show

Scottish GP workforce increases for first time in 10 years, figures show

GP numbers in Scotland have risen slightly for the first time in 10 years despite...

More than 16m GP practice appointments a year lost to DNAs

More than 16m GP practice appointments a year lost to DNAs

More than 16m appointments at GP practices are lost every year because patients fail...

Six ways GPs can help patients with asthma to stay well this winter

Six ways GPs can help patients with asthma to stay well this winter

Up to 26,000 people could be hospitalised with asthma this winter. GP and Asthma...

Red flag symptoms: Hirsutism

Red flag symptoms: Hirsutism

There are a number of possible causes for this symptom, explains Dr Pipin Singh

A day in the life of a prison GP

A day in the life of a prison GP

Dr Patrick Staite tells GP Jobs what it is like to work as a prison GP.