Therapeutic evaluation of efficacy of intralesional bleomycin in common warts including palmo-plantar and periungual warts: a prospective study

Prabal Kumar, Karaninder Singh Mehta, Vikram Mahajan, Pushpinder Singh Chauhan


Background: Commonly used destructive treatment modalities for common warts though effective, are associated with pigmentary changes, scarring and recurrences. Treatment with immune modulators or immunotherapy has shown variable results. We evaluated efficacy and safety of intralesional bleomycin for treating common warts including palmoplantar and periungual warts.

Methods: Two hundred patients with common, palmar, plantar and periungual warts (having 753 warts) were treated with two intralesional injections of bleomycin 1 mg/ml at two weekly intervals. They were followed up at 4weeks and 12 weeks for cure, adverse effects and partial clearance or recurrence.

Results: Only 183 (M: F 95:88) patients having 703 warts completed the study. Overall, complete clearance in 669 (95.16%) warts in 156 (85.2%) patients and partial clearance in 24 (3.4%) warts in 21 (11.4%) patients were observed. Patients with complete/partial clearance were highly satisfied from the treatment. Recurrence was seen in 6 (3.27%) patients. Most patients had injection site pain for 2-3 days not warranting discontinuation of treatment. Other adverse effects included temporary hyperpigmentation in 46, altered skin texture in 12 and injection site infection in 6 patients, respectively.

Conclusions: Intralesional bleomycin appears effective, safe, and acceptable treatment modality for common warts including palmoplantar and periungual warts. It carries the advantage of low dose, insignificant adverse effects and high patient satisfaction. 


Warts, Bleomycin, Intralesional, Immunotherapy

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Bacelieri R, Johnson SM. Cutaneous wart: an evidence based approach to therapy. Am Fam Physician 2005;72:647-52.

Gibbs S, Harvey I, Sterling J, Stark R. Local treatments for cutaneous warts: systematic review. BMJ. 2002;325(7362):461.

Lipke MM. An armamentarium of wart treatments. Clin Med Res. 2006;4:273-93.

Rivera A, Tyring SK. Therapy of cutaneous human papillomavirus infections. Dermatol Ther. 2004;17:441-8.

Lichon V, Khachemoune A. Plantar warts: a focus on treatment modalities. Dermatol Nurs. 2007;19:372-5.

Dasher DA, Burkhart CN, Morrell DS. Immunotherapy for childhood warts. Pediatr Ann. 2009;38:373-9.

Chauhan PS, Mahajan VK, Mehta KS, Rawat R, Sharma V. The efficacy and safety of intralesional immunotherapy with MMR (Measles, Mumps, Rubella virus) vaccine for the treatment of common warts in adults. Indian Dermatol Online J. 2019;10:19-26.

Lewis TG, Nydorf ED. Intralesional bleomycin for warts: a review. J Drugs Dermatol. 2006;5:499-504.

Agius E, Mooney JM, Bezzina AC, Yu RC. Dermojet delivery of bleomycin for the treatment of recalcitrant plantar warts. J Dermatol Treat 2006;17:112-6.

Munn SE, Higgins E, Marshall M, Clement M. A new method of intralesional bleomycin therapy in the treatment of recalcitrant warts. Br J Dermatol. 1996;135:969-71.

Shelley WB, Shelley ED. Intralesional bleomycin sulfate therapy for warts. A novel bifurcated needle puncture technique. Arch Dermatol. 1991;127:234-6.

Al Ghamdi KM, Khurram H. Successful treatment of periungual warts with diluted bleomycin using translesional multipuncture technique: a pilot prospective study. Dermatol Surg. 2011;37:486-92.

Van der Velden EM, Ijsselmuiden OE, Drost BH, Baruchin AM. Dermatography with bleomycin as a new treatment for verrucae vulgaris. Int J Dermatol. 1997;36:145-50.

Pollock B, Sheehan-Dare R. Pulsed dye laser and intralesional bleomycin for treatment of resistant viol hand warts. Laser Surg Med. 2002;30:135-40.

Takigawa M, Oku T, Ginoza M, Yamada M, Yamamoto T Kobayashi I. Treatment of viral warts with pressure-sensitiv adhesive tape containing bleomycin sulfate. Arch Dermatol. 1985;121:1108.

Ryu HR, Jeong HR, Seon-Woo H-S, Kim JS, Lee SK, Kim HJ, et al. Efficacy of a bleomycin microneedle patch for the treatment of warts. Drug Deliv Transl Res. 2017;8:273-80.

Bunney MH, Nolan MW, Buxton PK, Going SM, Prescott RJ. The treatment of resistant warts with intralesional bleomycin: A controlled clinical trial. Br J Dermatol. 1984;110:197-207.

Shumer SM, O’Keefe EJ. Bleomycin in the treatment of recalcitrant warts. J Am Acad Dermatol. 1983;9:91-96.

Hayes ME, O’Keefe EJ. Reduced dose of bleomycin in the treatment of recalcitrant warts. J Am Acad Dermatol. 1986;15:1003-6.

Amer M, Diab N, Ramadan A, Galal A, Salem H. Therapeutic evaluation for intralesional injection of bleomycin sulfate in 14 resistant warts. J Am Acad Dermatol. 1988;18:1313-6.

Sollitto RJ, Napoli RC, Gazivoda PL, Hart TJ. A perspective study using bleomycin sulfate in the treatment of plantar verrucae. J Foot Surg 1989;28:141-4.

Golchai J, Karegar MMMV. Therapeutic evaluation of intralesional injection of bleomycin sulfate in the treatment of resistant warts. Med J Islam Repub Iran 1995; 8:233-6.

Sollitto RJ, Napoli RC, Gazivoda PL, Hart TJ. Bleomycin sulfate in the treatment of mosaic plantar verrucae. A follow-up study. J Foot Ankl Surg. 1996;35:169-72.

Salk R, Douglas TS. Intralesional bleomycin sulfate injection for the treatment of verruca plantaris. J Am Podiatr Med Assoc. 2006;96:220-5.

Dhar SB, Rashid MM, Islam A, Bhuiyan M. Intralesional bleomycin in the treatment of cutaneous warts: A randomized clinical trial comparing it with cryotherapy. Indian J Dermatol Venereol Leprol. 2009;75:262-7.

Soni P, Khandelwal K, Aara N, Ghiya BC, Mehta RD, Bumb RA. Efficacy of intralesional bleomycin in palmo-plantar and periungual warts. J Cutan Aesthet Surg. 2011;4:188-91.

Aziz-Jalali M, Ghafarpour G, Rezaei M, Heshmatzadeh Behzadi A, Rohani Nasab M, Nilforoushzadeh M. Efficacy of Intralesional bleomycin in the treatment of resistant warts. J Skin Stem Cell. 2014;1:e18875.

Kruter L, Saggar V, Akhavan A, Patel P, Umanoff N, Viola KV, et al. Intralesional bleomycin for warts: Patient satisfaction and treatment outcomes. J Cutaneous Med Surg. 2015;19:470-6.

Al-Naggar MR, Al-Adl AS, Rabie AR, Abdelkhalk MR, Elsaie ML. Intralesional bleomycin injection vs microneedling-assisted topical bleomycin spraying in treatment of plantar warts. J Cosmet Dermatol. 2019;18:124-8.

Barkat MT, Abdel‐Aziz RT, Mohamed MS. Evaluation of intralesional injection of bleomycin in the treatment of plantar warts: clinical and dermoscopic evaluation. Int J Dermatol. 2018;57:1533-7.

Unni M, Tapare V. Intralesional bleomycin in the treatment of common warts. Indian J Drugs Dermatol. 2017;3:73-6.

Mehta KIS, Mahajan VK, Chauhan PS, Chauhan S, Sharma V, Rawat R. Evaluation of efficacy and safety of intralesional bleomycin in the treatment of common warts: Results of a pilot study. Indian J Dermatol Venereol Leprol 2018.

Adalatkhah H, Khalilollahi H, Amini N, Sadeghi-Bazargani H. Compared therapeutic efficacy between intralesional bleomycin and cryotherapy for common wart: A randomized clinical trial. Dermatol Online J. 2007;13:4.

Bremner RM. Warts: Treatment with intralesional bleomycin. Cutis. 1976;18:264-6.