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Bowen's Disease

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It's appearance is an enlarging, distinctly defined plaque with an irregular border and surface crusting or scaling.

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      01.07.2008 15:41
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      What ever skin colouring you are protect your skin from the sun.

      About 13 years ago whilst I was living in Portugal I noticed a small spot on my first finger, left hand. I didn't think anything of it at the time as it was only the size of a pin head. However as time passed the spot grew larger and became red and inflamed. Sometimes it would itch and have particles of flaky skin come away from the finger when I scratched it. One day it was irritating me so I went to the Farmacia. In Portugal in those days it was cheaper to go and show the pharmacist your wounds or tell them your ailments as they were qualified to prescribe drugs and usually they were very good. You could buy antibiotics, valium , anything really, over the counter without a prescription but now it is more regulated.

      This particular pharmacist looked at the finger and said it was eczema and gave me some cream. I was happy with that diagnosis and off I went. Two weeks later there was no change so I made an appointment with a private German doctor who I had seen before on an other occasion. Nice lady, very easy to talk to . Having examined the finger and asked a few questions she also said it was eczema and prescribed another cream. Now, I was convinced it was eczema and I thought I would just have to put up with it, keep applying the cream and eventually it will go away or at least keep it under control.

      Literally years passed and I never gave the finger any thought. Occasionally it flared up but I didn't really pay any attention to it. The damaged area gradually grew in size but I can honestly say that I wasn't worried about it. In 2002 we decided to move back to UK to Cumbria and one day sitting in my cottage watching TV my son grabbed my hand and said, 'For God's sake Mum will you get that finger sorted out. It is a mess and looks horrible.' I said, 'Yes, I suppose so.' but just thought he was being melodramatic.

      However I did book an appointment at the local surgery. The doctor I saw was a trendy, okay yah type. She asked me loads of questions about diet - which is fine, as I am very good at eating properly. She asked me if I smoked - No never, then came the bit about how many units did I consume per day. Well I told a bit of a fib there - does anybody else tell the truth on that queston? I said the right amount knowing damn well I drink more but hey, life's too short. After the health interrogation she eventually looked at the finger and yes, she said it looks like eczema and gave me some cream. Away I trotted off again. After 3 weeks - no change. The sore patch on the finger was red, scabby and the size of a 50p coin. I was a bit fed up by then so went back and this time she did a swab and took some of the flaky skin and sent it to the lab but it came back clear. Feeling very frustrated because by now it was a mess, flakes of skin kept falling off making the area red and very sore, I went back and asked if she could book an appointment with a dermatologist at the hospital which she did.

      After a 6 week wait I eventually saw the head consultant who was a very nice and patient man. He said that he would have to do a biopsy before they could actually find out what was causing this. He asked how long had I had this ailment, did I have any tropical fish or keep birds which at the time I thought he was barmy but I suppose they do spread certain diseases. No was the answer to those questions. None of the questions seemed relevant to me but they were obviously relevant to him but I did say to him, I would like to point out that I have lived in the sun for 10 years spending most of that time working and living outside. He wrote all this information down and then I had to go into another room where he was going to do a very small operation on my finger. I said, 'Will it hurt as I am very squeemish and have a very low pain threshold.' 'No it won't hurt,' he said and it didn't as he froze the finger. He cut a small chunk of my finger out and put it in a little bottle to be sent away to be analysed, stitched the finger and sent me home to wait the results.

      I left the hospital feeling very confident as I trusted this doctor and I was sure he would get to the bottom of it. Next thing, 4 weeks later, a letter arrived from the hospital which I knew would be the results from the tests but when I opened it I was really shocked. I think I cried. The letter said something along the lines - we now have the pathology report from your left index finger which showed Bowen's disease. I have enclosed an information leaflet on this condition. I knew nothing about this disease but when reading the letter something at the back of my mind kept saying - That is skin cancer isn't it?. I was quite scared until I found out more about the disease and the treatment.

      So what is Bowen's disease?
      ***********************

      It is a localised skin growth confined to the epidermis. It usually appears as a slowly enlarging red scaly patch, often on the lower legs. I might add at this stage that this may be one of the reasons that it wasn't diagnosed quickly as mine is on my finger. It is most common in women and about 20% of women with this disorder have more than one patch. It is thought partly to develop as a result of long term sun exposure. I will also mention that I never sun bathe and I am not fair skinned. Unfortunately I have this disorder with just working in the sun and going about every day life. Both my son and husband are very fair skin but they have not had any problems.

      Bowen's disease is not infectious and often causes no symptoms . The patches grow very slowly. Occasionaly they can develop into a true skin cancer. On some web sites it states that Bowen's disease is skin cancer in it's very earliest phase. Dermatologists like to monitor this disease and treat it in one of the following ways:

      Freezing. This can be done in the clinic. It causes redness , puffiness, blistering or crusting. It may be slow to heal.

      Excision - Cutting the patch out

      Efudix cream - usually applied daily until the patch becomes a bit read and itchy.

      The treatment prescribed in my case was Efudix cream. This is a cream which is very useful in dermatology and to treat certain sunlight induced areas of crusting on the skin, such as actinic (solar) keratoses or Bowen's disease. I had to use the treatment for 4 weeks initially. Every night I had to cover the lesion about an hour before going to bed. This cream is quite destructive in a way that it seriously burns the skin which is what it is supposed to do. It is to kill the bad cells. What does happen after 2 or 3 days the finger becomes very red and swollen and blistered. I was also given a cream to put on when this happened to soothe the inflamation but later found out that because this was a steroid cream it was actually thinning my skin. If I look at my finger now the skin around the affected area is very fine, like tissue paper.

      After four weeks the cream had worked and the crusty, scabby area had gone leaving the finger scarred but healed. I still had to go back to the consultant for check ups which were every 3 months. Unfortunately after 3 months it came back again just around the edges of the old wound. This time the consultant used liquid nitrogen on the lesion which is like a serious dose of freezing. This hurts actually and forms huge blisters afterwards.
      Also I had felt and noticed a small crusty brown area on my nose,
      I told him and pointed to the area and he said , 'Oh yes, that is an actinic keratosis, a marker of sunlight damage of the skin. He said the skin wasn't too bad at the moment and if I used Solaraze Gel it should soften and keep it under control.


      Actinic keratoses should be monitored by a dermatologist as they have the potential to progress to squamous cell carcinoma, a type of skin cancer that can be fatal. The risk of an actinic keratosis turning into a skin cancer is approximately 1/1000. It is known that anyone who develops AK's are more susceptible to other forms of skin cancers including melanoma which can be serious as it spreads to organs and the lymph glands.
      Sun exposure is the main cause of AK's as the sun causes the cells to change in shape and size and can even damage the dermis which is the layer of skin underneath the epidermis.
      Luckily all the treatment I have had from the NHS has been good. My nose has cleared up and my finger is fine most of the time but every now and again Bowen's disease raises its ugly head but the Efudix cream seems to keep it inder control.
      If the diagnosis on my finger had been correct the first time and I had taken more interest in actually getting the problem sorted out it would have been cured a long time ago. That will teach me for being laid back about things. But seriously folks:

      Take care in the sun

      Always protect your skin with a good sunscreen to all exposed skin. One that has a Sun Protection Factor (SPF) of at least 15 and is broad-spectrum -- protects against both ultraviolet (UVA) and ultraviolet B (UVB) rays.

      I use a stonger factor 45 but that is because I am prone to this disease and I never sit in the sun and always wear a daft hat even though it isn't at all flattering.

      Remember to keep re-applying the sunscreen every 2 hours specially after swimming.

      Wear a hat

      Wear good quality sun glasses

      Take extra care if taking part in water sports, snow sports or even just being on the sand.

      If you notice any suspicious lesions on your skin go and get it checked out. If caught in the early stages, AKs and all types of skin cancer are treatable and in most cases, curable. Take time to study your skin and if you are concerned see a dermatologist as they are more qualified in my view than a GP.

      Sometimes lesions can appear, disappear and then re-appear. Don't try picking at the skin thinking that they will go away as they won't. Also don't think that only fair skinned people are susceptible to these skin lesions - not true. Now that the sun is here look after your skin.

      NB. I have had to give a rating but ignore it as you can't really rate something like this.

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