DOI: http://dx.doi.org/10.18203/issn.2455-4529.IntJResDermatol20211387

Intralesional bleomycin in palmoplantar and periungual warts: a therapeutic study

Gayatri Devi B., P. V. Krishnam Raju, K. V. T. Gopal, Vanapalli R. Sneha

Abstract


Background: Warts are one of the most common benign growths of skin caused by human papilloma virus. No single treatment has proved to be completely effective and most therapies for palmo-plantar and periungual warts remain unsatisfactory. The present study was conducted to evaluate the therapeutic efficacy and safety of intralesional bleomycin injection in palmo-plantar and periungual warts in patients in region of south east India.

Methods: Ninety patients of multiple palmo-plantar and periungual warts were included in the study. They were infiltrated with bleomycin (1 mg/ml) till blanching. The treatment was repeated after paring of eschar at 2 weeks interval in cases with partial or no response. The patients were reviewed at monthly interval for 24 weeks to note cure, adverse effects, recurrence and outcome satisfaction levels.  

Results: Out of total 305 warts, 103 (34%) were cured after 1st injection and 249 (82%) were cured after 2nd injection. The number of warts requiring more than 2 sittings was 55 (18%). At the end of study, overall cure rate was 94.5% and 10 patients showed recurrence.

Conclusions: Intralesional bleomycin injection is an effective and safe treatment option in palmo-plantar and periungual warts.


Keywords


Bleomycin, Palmo-plantarwarts, Periungual warts

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References


Sterling JC .Virus infections. In: Burns T, Breathnach S, Cox N, Griffiths C, editors. Rook’s Textbook of Dermatology. 8th edition. Oxford: Wiley Blackwell. 2010;33:39-60.

Sterling JC, Gibbs S, Hussain SSH, Mustapa MFM, Handfield-Jones SE. BAD guidelines for management of cutaneous warts. Br J Dermatol. 2014;171:696-712.

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

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

Cordero AA, Guglielmi HA. Woscoff A. The common wart. Intralesional treatment with Bleomycin sulfate. Cutis. 1980;26:319-24.

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.

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.

Gibbs S, Harvey I. Topical treatments for cutaneous warts. Cochrane Library. Chichester: John Wiley and Sons. 2007;4.

Gibbs S, Harvey I, Sterling J, Sterk R. Local treatments for cutaneous warts: Systemic review. BMJ. 2002;325:461-7.

Thomas KS, Keogh-Brown MR, Chalmers JR, Fordham RJ, Holland RC, Armstrong SJ, et al . Effectiveness and cost-effectiveness of salicylic acid and cryotherapy for cutaneous warts: An economic decision model. Health Technol Assess. 2006;10:9-87.

Singh Mehta KI, 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. 2019;85:397-404.

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;1:18875.

Shumer SM, O'Keefe EJ. Bleomycin in the treatment of recalcitrant warts. J Am Acad Dermatol. 1983;9:91-6.

Saitta P, Krishnamurthy K, Brown LH. Bleomycin in dermatology: A review of intralesional applications. Dermatol Surg. 2008;34:1299-313.

Hayes ME, O'Keefe EJ. Reduced dose of bleomycin in the treatment of recalcitrant warts. J Am Acad Dermatol. 1986;15:1002-6.

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

Sterling JC, Handfield-Jones S, Hudson PM; British Association of Dermatologists. Guidelines for the management of cutaneous warts. Br J Dermatol. 2001;144:4-11.

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.

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.

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.

Adalatkhah H, Khalilollahi H, Amini N, Sadeghi-Bazargani H. Compared therapeutic efficacy between intralesional bleomycin and cryotherapy for common warts: a randomized clinical trial. Dermatol Online J. 2007;13(3):4.

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