Bowenoid papulosis is a rare condition that shares typical histologic features with Bowen’s disease; however, Bowenoid papulosis usually shows a lesser degree of cytologic atypia. Recently, some cases of Bowen’s disease that were successfully treated with ingenol mebutate gel have been reported1,2. Ingenol mebutate, a novel agent derived from the sap of Euphorbia peplus, has been revealed to have a dual mechanism of action in a recent study3, including the rapid necrosis of lesional cells and specific neutrophilmediated, antibody-dependent cellular cytotoxicity. It has also been shown to be effective in the treatment of actinic keratosis4. To date, no case of Bowenoid papulosis treated with ingenol mebutate gel has been reported. Herein, we report a case of Bowenoid papulosis successfully treated with ingenol mebutate gel and fractional CO₂ laser. The patient was a 33-year-old man who presented with a few small brown papules on the shaft of the penis (Fig. 1A). A skin biopsy was performed and the specimen revealed histologic features of Bowenoid papulosis (Fig. 1C, D). The lesion was pretreated with fractional CO₂ laser (eCO₂ ^Ⓡ, Lutronic, Korea) with the following parameters: tip size 120 μm, peak power 30 W, pulse energy 50 mJ, 200 spots/cm2. Ingenol mebutate 0.05% gel (PICATO^Ⓡ, LEO Pharma, UK) was then applied to the lesions once following fractional CO₂ laser pretreatment. After 3 treatments, with 3-week intervals between each treatment cycle, the brown papules completely disappeared (Fig. 1B). Local skin reaction including erythema and bulla formation was noted, but it subsided with conservative treatment. Significant adverse effects including infection or scar formation were not observed. No evidence of recurrence was observed during the 13-month follow-up period. Since the lesions in Bowenoid papulosis generally show a more protruding and irregular surface than those in Bowen’s disease, we utilized a fractional CO₂ laser to produce vertical holes through the irregularly thickened epidermis in order to accelerate the penetration and accumulation of ingenol mebutate. Fractional CO₂ laser has already shown good efficacy in treating precancerous or cancerous lesions with photodynamic therapy by enhancing the penetration and accumulation of photosensitizers5. To our knowledge, this is the first reported case of Bowenoid papulosis successfully treated with ingenol mebutate after pretreatment with fractional CO₂ laser, and further well-controlled clinical trials are needed to validate the efficacy and safety of ingenol mebutate gel in patients with Bowenoid papulosis.