A hospital-based single-arm study to assess the efficacy of intralesional bleomycin injection in patients of resistant periungual and palmoplantar warts

Objectives: The objective of the study is to assess the efficacy of intralesional (I/L) bleomycin therapy for the treatment of resistant periungual and palmoplantar warts. Materials and Methods: A total of 51 patients of age ≥13 years with periungual and palmoplantar warts for ≥3-month duration and non-responsive to at least two conventional treatment modalities were included in this study and treated with I/L bleomycin (1.5 mg/mL solution) every 2 weeks for maximum up to two injections. The patients were followed up every 2 weeks up to 3 months. If warts did not regress in size after 3 months of starting treatment, it was considered as failure. Results: A total of 51 patients were included in the study who presented with 146 warts. 38 (74.5%) patients were treated with a single dose of I/L bleomycin, and 13 (25.5%) patients received two doses at an interval of 2 weeks. Complete clearance (CC) was seen in 37 (72.5%) at 2 weeks and near CC (NCC) in 13 (25.6%) of patients at 4 weeks. Recurrence was observed in one patient (1.9%) after achieving NCC initially. Mild-to-moderate pain was the most common side effect (98%) reported, which lasted up to 2-3 days in 20% of the patients, with a peak at the time of injection. Perilesional hyperpigmentation was seen in 41 (80.3%) patients that gradually faded during the follow-up of 12 weeks. Eschar formation and necrosis of lesions were seen in 7 (13.7%) and 3 (5.8%) patients, respectively. A single patient experienced Raynaud’s phenomenon who finally was lost to follow-up. Limitations: Limited number of patients, lack of control group, and short follow up period were the main limitations of the present study. Conclusion: Intralesional bleomycin is a highly effective and safe treatment option for periungual and palmoplantar warts, which are usually resistant to conventional treatment modalities..