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Plantar warts are common and often painful. Treatment of plantar warts is difficult and requires multiple treatments. Several clinical trials have proven the efficacy of bleomycin, but relatively high concentrations have been required and considerable side effects have been experienced.
To evaluate the efficacy and safety of low-concentration (0.1 U/mL) bleomycin using a translesional injection technique for the treatment of plantar warts.
The study included 23 patients with single or multiple plantar warts. Very low-concentration bleomycin was injected into a single wart or the largest plantar wart in the case of multiple lesions. Injections were performed at 4-week intervals until resolution of the warts or development of side effects. The translesional multipuncture technique was used.
Thirteen patients were male (56.5%), and the mean age was 27.7 years. The results revealed complete clearance of warts in 17 of 23 (74%) patients, partial response in 1 (4.3%) patient, and no response in 3 (13%) patients. Recurrence was observed in 2 patients at 3 months of follow-up. Among those two, one patient showed complete clearance after the second injection at 6 months of follow-up. All patients were followed for 6 months after the initial treatment. No significant long-term adverse effects were noted. Only three patients (13%) had localized moderate pain for 2 to 3 days after the injection.
Translesional injection by very low-concentration (0.1 U/mL) bleomycin appears to be a simple, effective, and safe treatment modality for plantar warts.
Background: Warts are benign tumors of the skin and mucosa and are caused by human papilloma virus (HPV). They are one of the most common skin diseases found mainly in children and adolescents. Although most of the warts disappear spontaneously or respond to the usual therapeutic measures, resistant forms of the warts impose a problem in dermatology. Intralesional injection of bleomycin has been tried in the treatment of resistant warts with variable results in different studies.
Objectives: This study aimed to assess the efficacy of intralesional injection of bleomycin in resistant warts.
Patients and Methods: In this cross-sectional study, a total of 130 warts in 30 patients were treated with 1 mg/mL intralesional injection of bleomycin. Patients received one to three doses of bleomycin every four weeks, and were followed for six months. Response to the treatment was categorized as complete resolution, partial resolution, and nonresponsive. We employed SPSS version 13 to perform t test and analysis of variance (Anova) as statistical methods for analyzing the data.
Results: Out of 130 warts, 126 (97%) cases showed resolution after bleomycin injections. Ninety-five warts (73%) showed complete resolution and 31 (24%) cases showed incomplete resolution. The cure rate (80%) was better in warts with the size smaller than 20 mm in diameter in comparison with larger lesions (46%). After six months follow-up, 7 patients showed recurrence. Recurrence was seen more among those with greater number of warts.
Conclusions: This form of treatment for resistant warts would be reliable, safe, and acceptable to the patients if it is performed under care and with proper dose and concentration.
The treatment of warts is challenging with regards to both tolerability and efficacy.
Ascertain the efficacy, tolerability, and patient satisfaction of intralesional bleomycin in the treatment of warts.
Retrospective chart review followed by telephone interviews with patients from university-based dermatology referral centers.
Seventy-four percent (34/46) of patients had complete resolution (CR) of all warts. Of 34 patients who experienced CR, an average of 1.7 treatments were required. Pain experienced during the procedure and recovery, irrespective of outcome, was rated 5.8 out of 10 (range, 1-10; SD, 2.72; SEM, 0.40). Approximately 70% of patients had pain that lasted less than 2 days after treatment. Seventy-eight percent (36/46) of patients in the study were satisfied with treatment and would recommend it to others.
Patients felt bleomycin to be an effective treatment modality for warts, offering high rates of CR in lesions resistant to more traditional therapies.