Successful Treatment of Periungual Warts with Diluted Bleomycin Using Translesional Multipuncture Technique: A Pilot Prospective Study

Abstract

BACKGROUND: The treatment of periungual warts is a therapeutic challenge. Various treatment modalities can be ineffective and may cause scarring and permanent nail changes. OBJECTIVES: A prospective pilot study to investigate the efficacy and safety of a low concentration (0.1 U/mL) of bleomycin in the treatment of periungual warts. METHODS: Periungual warts were injected with bleomycin (0.1 U/mL) every 4 weeks until elimination of the lesions or until the injections were discontinued because of adverse effects. Bleomycin was administered using the translesional multipuncture technique. RESULTS: We recruited 15 patients with periungual warts from March 2007 to March 2008. Thirteen patients were male (86.6%); median age was 30. Seven patients (46.6%) demonstrated complete clearance 1 month after the first injection; two required two treatment sessions. Thirteen (86.6%) patients had complete clearance of the treated wart at the 6-month follow-up with only one injection. Wart recurrence was observed in two patients. All patients were followed for 6 months after the initial treatment. No significant long-term adverse effects were noted. Only one patient demonstrated mild postinflammatory hyperpigmentation, which resolved after 1 month, and nine (60%) had localized moderate pain for 2 to 3 days after the injection. CONCLUSION: Translesional multipuncture treatment with a low concentration (0.1 U/mL) of bleomycin is an effective modality for periungual warts that results in minimal side effects. Larger controlled studies are needed.