Intralesional bleomycin has been used for the treatment of warts since the 1970s. Currently, there is a limited amount of evidence from randomized placebo-controlled trials comparing intralesional bleomycin with other local treatments for warts. Numerous reports have been published on the use of intralesional bleomycin for the treatment of recalcitrant warts with cure rates ranging from 14% to 99%. The majority of the data suggests that bleomycin is effective in over two-thirds of the reported cases with minimal side effects. In this paper, we review the mechanism of action, pharmacokinetics, safety profile, supply and storage, dosage scheme, techniques for administration, and efficacy of intralesional bleomycin for the treatment of warts.
Bleomycin is a chemotherapeutic agent that inhibits DNA synthesis in cells and viruses. 9 It causes acute tissue necrosis that may stimulate an immune response. 10 There is no consistent evidence regarding the effectiveness of bleomycin for nongenital cutaneous warts. In five RCTs, cure rates ranged from 16 to 94 percent; one trial even showed higher cure rates in the placebo group. 2 , 7 Adverse effects of bleomycin include pain, swelling, and redness for one week after treatment. Necrosis in the skin may cause scarring, pigment change, or nail damage. Because treatment can lead to significant systemic drug exposure, bleomycin should be avoided in children, pregnant women, and patients with peripheral vascular disease or Raynaud disease. 27 Patients are usually referred to a dermatologist for this treatment.