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

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.