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

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.


  • 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.

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.


  • 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.

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