Penyakit Bowen | Penghormatan

Perkara yang Perlu Diketahui Mengenai Penyakit Bowen

Bowen’s disease is a pre-cancerous skin condition that usually affects older adults. Learn about its causes, symptoms, and prevention in this article.

oleh Calvyn Ee

About Bowen’s Disease

Bowen’s disease, often referred to as “squamous cell carcinoma in situ,” is a precancerous skin condition that usually appears in the form of a red/dark brown scaly patch of skin that slowly grows in size. Bowen’s disease affects the epidermis (hence the use of the term “in situ”), the outermost layer of the skin, and can affect any part of the body. it doesn’t present other symptoms beyond an itch, but can still become a life-threatening condition if left untreated.

Causes of Bowen’s Disease

The leading cause of Bowen’s disease is prolonged UV exposure. While sunlight does have its share of health benefits, particularly in providing vitamin D, too much of it is not good for your body. Prolonged UV exposure is one of many causes of skin cancers, as UV radiation damages the fibres of your skin. When this occurs, your skin may become a lot easier to bruise or tear, and may take longer to heal as well.

It’s a common mistake to think that having glowing skin from a suntan is a good sign of health. On the contrary, it only puts you at great risk of not only developing Bowen’s disease (and later skin cancer) but also freckles and liver spots. Ideally, you should avoid being out in the sun for too long, especially between 10am to 4pm where UV rays are at their strongest.

UV exposure doesn’t just come from natural sunlight, but also from artificial sources as well. These may include:

  • Sunlamps or tanning beds: These devices emit UV radiation so a person can get a tan without going out in the sun
  • Black-light lamps: You may see these commonly used at cashiers to check for counterfeit ringgit notes. They emit a low purple light
  • Mercury-based lamps: These come in various forms and are used for various purposes

What Does “Precancerous” Mean?

Bowen’s disease is considered pre-cancerous because it can inevitably lead to skin cancer. In this case, too much UV radiation can cause changes to your DNA. This may result in cells not functioning as they should, replicating uncontrollably, and becoming cancerous cells. These cancerous cells can invade the dermis, the inner layer of the skin, and then form a cancerous tumour, which is what causes skin cancer.

It’s for this reason that early detection and treatment of Bowen’s disease is critical. The early prevention of skin cancer goes a long way to ensuring you can live a long and fruitful life.

Risk Factors of Bowen’s Disease

We’ve already shared how prolonged exposure to sunlight can be dangerous, but other risk factors include:

  • Gender: Women are more susceptible to Bowen’s disease than men
  • Age: Persons above the age of 40 are at higher risk of Bowen’s disease
  • Arsenic exposure: Arsenic is a tasteless, colorless metal element commonly used in manufacturing and other industries. People who are often exposed to arsenic, accidentally or otherwise, are at significant risk of developing Bowen’s disease, in some cases approximately 10 years after initial exposure
  • HPV infection: Those with the human papillomavirus (HPV) are also at risk. Some forms of HPV can cause Bowen’s disease in other parts of the body that aren’t very exposed to sunlight. Of particular note is the rare condition called Bowenoid papulosis, which has similar features as Bowen’s disease but is caused by a variant of the HPV infection
  • Radiotherapy: Prolonged radiotherapy is said to be a potential risk factor for the disease
  • Immunosuppressants: These medications are taken to weaken the immune system to help treat inflammations or autoimmune diseases. As a result of a weaker immune system, you are at greater risk of developing Bowen’s disease

Is Bowen’s Disease Hereditary?

Thankfully, Bowen’s disease is not hereditary – that is, it doesn’t run in families. Some risk factors that can cause it are hereditary, but the disease itself is not.

It also isn’t infectious, so there’s no need to worry about passing it on to others. Immediate treatment is still the best way to effectively manage the condition before it becomes cancerous.

Symptoms of Bowen’s Disease

The primary symptom is a slow-growing patch of dry, scaly skin, usually taking the form of red or brown lesion. The lesions don’t cause any pain, but they can itch, bleed, ooze pus, or become crusted/tender. Normally, only one lesion forms, but there are a few instances where it’s found on other parts of the body. It also can form in areas that aren’t heavily exposed to sunlight

Sometimes, the affected part(s) may look like warts or raised spots instead of a patch or lesion. If you notice a “fleshy nodule” or bump on the affected area, you may need to get it checked quickly, as that may be an early sign of a cancerous growth.

Should I Be Worried About Bowen’s Disease?

If you get it treated promptly, there should be no reason for you to worry. Bowen’s disease can be treated fairly quickly once it’s been detected. A thorough diagnosis will be needed to prevent a misdiagnosis, as Bowen’s disease can be confused for skin diseases with similar symptoms such as psoriasis. In fact, progression from Bowen’s disease to something more serious occurs in one in 20 to one in 30 people whose Bowen’s disease is still untreated.

Diagnosing generally starts off with a simple medical examination, where the doctor will examine your body and look at the affected patch. Lab tests may be needed to correctly identify the condition, so a biopsy – where a skin sample is taken – may be performed.

Once a diagnosis has been made, treatment can begin almost immediately.

Treating Bowen’s Disease

The treatment plan will be based on a number of criteria, including (but not limited to):

  • The number of patches on your body
  • The size and thickness of the patches
  • The severity of patches
  • The presence of other symptoms
  • Your age and overall health

For the most part, Bowen’s disease has a very positive outlook with treatment. Most, if not all, available therapies have a very high success rate, so again, there’s nothing to worry about. Moreover, your doctors will be there to provide you with advice on what to do, what medications you may need, and so forth. Don’t hesitate to get their help if you need it.

Topical Cream

The two topical creams used are 5-fluorouracil and imiquimod. 5-fluorouracil kills abnormal skin cells in the affected area, preventing them from reproducing. Imiquimod is used to treat a variety of skin conditions and even genital warts. The properties of the cream increase immune system activity enabling it to treat Bowen’s disease.

Both creams may be used in conjunction with other forms of treatment to help hasten the treatment process. There may be some side effects, such as inflammation, soreness, or redness, so be sure to talk to your doctor if you have any side effects as these could inform your treatment plan. These side effects usually subside after some time.

Curettage with Cautery

Curettage involves scraping off the skin from the affected area using a curette while you or your loved one are placed under local anaesthesia. Once done, they’ll finish up with cauterisation, lightly burning the skin with heat or an electric current to prevent further bleeding. The wound will slowly heal much like a scab. It may need to be repeated if there are cancer cells found in the deeper tissue of your skin.

Cryosurgery

Sometimes referred to as cryotherapy, this involves extreme cold (using liquid nitrogen or argon gas) to freeze, then destroy, tissue and cells in the affected area. It’s a minimally invasive procedure that is used to treat small patches of Bowen’s disease.

Conventional Surgery/Excision

This is a common treatment method where the lesion is cut out and the wound is sealed with sutures. For larger or recurring lesions, or if it affects areas that require careful surgical action, Mohs micrographic surgery may be needed to precisely remove the diseased tissue one layer at a time.

Photodynamic Therapy (PDT)

This is a more specialised treatment method where a topical chemical is applied to the affected area of the skin. This cream makes the area where it’s applied to be more sensitive to certain wavelengths of light. A light is then shone onto the affected area, which “activates” the chemical to destroy the infected cells.

Preventing Bowen’s Disease

The simplest way to prevent Bowen’s disease is to reduce your overall exposure to UV radiation, especially during the day. This can seem impossible given how we’re always in the light of the sun every day, but you can still find ways to minimize UV radiation exposure.

  • If you have to be in sunlight for long hours, apply sunscreen to the parts of your body that will be exposed. Look for sunscreens that have SPF levels of at least 30, as they block as much as 97 percent of the sun’s UV rays
  • If you don’t have sunscreen available, wear a hat and cover up areas that will be exposed to sunlight (such as your limbs)
  • Get screened for Bowen’s disease; early detection can protect you from the risk of developing skin cancer
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Calvyn Ee
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