Bowen-like papulosis is a relatively rare independent vulvar skin disease with precise clinicopathologic features. It occurs mostly in young men and women with multiple pigmented warty papules on the vulvar or perineal skin. The pathomorphology is mainly characterized by heterogeneous hyperplasia of the epidermis, similar to Bowen’s disease, but with a mild degree, small lesions and a good prognosis, although cancer has been reported. Bowen-like papulosis is a relatively uncommon clinical condition, but its incidence has been on the rise in the last decade or so with the dramatic increase in the incidence of various STDs, especially condyloma acuminata. It is a type of multiple flat papules that occurs in the external genital area of young patients and shows histopathologic manifestations of low-grade malignant carcinoma in situ. It is often clinically confused with the papular form of condyloma acuminatum and is prone to misdiagnosis. The etiology of Bowen-like papulosis is not fully understood. It is thought that it may be related to human papillomavirus (HPV), Candida infection, herpes virus infection, etc. It is also thought that the disease occurs secondary to the action of different irritants on benign primary symptoms. The onset of the disease is often associated with sexual contact transmission as very few cases are often associated with other STDs such as condyloma acuminatum. Clinical symptoms Bowen-like papulosis occurs mainly in sexually active young patients around 21-30 years of age, slightly more in women than in men. The lesions appear as multiple or single pigmented papules, ranging in size from 2-10 mm in diameter, reddish-brown or brownish-black, round, oval, or irregular in shape, with clear boundaries, and the surface of the papules may be shiny and velvety or mildly keratinized and warty. The lesions are found on the skin and mucous membranes of the groin, external genitalia and perianal area, and in the penis, prepuce, glans and tether in men, and rarely in the scrotum. In women, the lesions are usually found on the labia majora and minora, the perineum, and also on the vaginal opening, groin and perianal skin. It is usually asymptomatic, but a few patients may have pruritus, inflammation and mild pain. It is often misdiagnosed clinically as a flattened acromegaly; therefore, it is essential to diagnose this disease in conjunction with histopathological examination. Pathology Bowen-like papulosis is histopathologically similar to Bowen’s disease and is characterized by psoriatic epidermal hyperplasia, hyperkeratosis with focal hyperkeratosis, marked granulomatous foci, loss of cell polarity, atypical nuclear division, and multinucleated, necrotic, atypical keratinocytes with dyskeratosis. The dermal papillary layer is edematous, with curved and dilated capillaries surrounded by chronic inflammatory cell infiltration. The main difference between Bowen-like papules and papular warts is that Bowen-like papules are multiple and occur singly and scattered, with a smooth surface and a light red, brown, purple or brown color. Therefore, Bowen-like papulosis should be diagnosed and treated at an early stage. Various treatment methods can be used for Bowen-like papulosis, such as electrocoagulation, freezing, erosive agents, local surgical excision, etc. However, there are defects such as poor patient tolerance, large trauma, easy scarring, and variable recurrence rate. In recent years, topical imiquimod has been reported to treat Bowen-like papulosis with certain efficacy. Photodynamic therapy, as a new and less invasive treatment method, has high specificity for condyloma acuminata and Bowen-like papulosis, can selectively induce cell death of human papilloma virus infection, and the recurrence rate is significantly reduced, and is well tolerated by patients and does not leave scars after healing.