In this study, we observed response to treatment in 97% and complete remission in 73% of warts resistant to treatment. This study showed that intralesional bleomycin injection could be advised as an effective treatment for resistant warts. Considering the different number and location of the warts in every patient, like some other similar studies, this study focused on the warts and their response to the treatment.
Regarding the 46% complete cure rate in warts larger than 20 mm versus 80% cure rate in warts smaller than 20 mm in diameter, it seems that the size of the wart before the treatment is an important factor in predicting response to the treatment. On the other hand, we observed higher recurrence rate in patients who had more warts, which should be considered in patients’ follow-up visits.
Drug concentration, injection times, frequency and duration of treatment, and follow-up period were similar to the previous studies (
12- 15). In this study, pain at injection site was the only complication and started in 26 (86%) patients, in the first to second day after injection. Seven patients had severe pain and needed to take oral analgesics, which proves the safety of this treatment method. In this study, no significant difference was detected with regard to the lesion location and response to treatment.
In previous studies conducted in our country (
15), this method was introduced as an effective method, especially after two sessions of injection in most patients, and few patients experienced wart relapse after two injections. The study also pointed that necrosis and pain were considered as a complication of this treatment. In more recent studies, like Salk et al. study ( 13) the cure rate was reported 87% after two injections although 13% of patients needed more than two injection sessions.
Besides, in Price study, the efficacy of this treatment was reported variable regarding the number of injections. In the study performed on 224 lesions, in 211 patients, 6.47%, 8.38%, and 8.9% of patients responded to one, two, and three injections respectively. In this study, less than 2% of patients had chemical cellulitis caused by injection. Sterile abscess hyperpigmentation at injection site were reported in 1% and the 0.5% of the patients respectively , which introduced this method as a reliable treatment with low complication (
Given the above findings, bleomycin injection for treatment of resistant warts is a preferred method in comparison with the other conventional methods such as using salicylic acid 40% in petroleum jelly, salicylic acid-lactic acid in collodion, trichloroacetic acid (TCA) 50%, cryotherapy by liquid nitrogen or carbon dioxide, and topical or oral retinoid acid (
The limitations of the present study are the lack of control group and short-time follow-up of the patients (not more than six months), which was mainly due to defects in follow-up process and also lack of patients compliance to complete the follow-up period.
Although warts are polymorphic and self-limited lesions, in some cases they may be very resistant and recurrent. Various conventional treatments would not be able to destroy these lesions completely. In such cases, bleomycin can be utilized with precaution (regarding the 97% cure rate resulted in our study) by the experienced physician with providing information pertaining to its probable side effects.