Resistant hand warts and warts found in difficult sites in immunosuppressed patients can be successfully treated by combining pulsed dye laser and intralesional bleomycin.
Initial treatment with pulsed dye laser prepares the wart for the bleomycin injection and ensures it goes into the base of the wart to minimise the risk of infiltration of normal skin. This new technique for safely administrating bleomycin into warts was tested by two investigators at Leeds Laser Centre, Leeds General Infirmary, England.
Their open study of ten patients with resistant viral hand warts of at least three years duration included four on long-term immunosuppressant drugs. A total of 18 warts were treated. Following anaesthesia with 1% lignocaine to the local area, warts were treated with a pulsed dye laser (7 mm spot, fluence 10 J/cm²). Bleomycin (0.5 IU/ml) was then injected into the base of the wart and subjects were followed-up with monthly treatment.
All eight warts in the six immunocompetent subjects were successfully cleared, as were eight out of ten warts in the immunosuppressed patients. In total, all but two of the 18 warts, 89 percent, were cleared.
While the remaining two warts partially responded to two treatments, no further therapy was given because the patient was happy with the result. There were no serious side effects in any of the subjects.