Pulsed dye laser and intralesional bleomycin for the treatment of recalcitrant cutaneous warts

Viral warts are a common ailment. Clinicians often combine multiple treatments to boost efficacy. One such novel combination is pulsed dye laser with bleomycin intralesionally (PDL + BI), described for the successful treatment of single hand warts.

To evaluate PDL + BI for the treatment of poor prognosis hand and foot warts.

This 4-year retrospective case series examined the efficacy of PDL + BI used consecutively on patients whose warts were treated with this modality alone. PDL 595 nm was used in stacking mode to achieve hemorrhagic blistering prior to intralesional bleomycin (1 mg/ml normal saline).

Twenty cases (65% male, age 13-62, mean age 42) were identified. Two (10%) were immunocompromised. Twenty five percent of warts affected hands, 55% feet, 20% both. Thirty five percent were solitary >1 cm(2) , 40% were multiple or mosaic verucae. The mean duration was 5.1 years (0.5-15). Seventy five percent received local anesthetic. Mean number of treatments was two. Post-operative pain varied from none to severe, sometimes causing difficulty in walking. Blistering and crusting disappeared after 17 days (range 7-42). Outcome had a mean follow-up of 24 months (3-53) with 60% complete response, 15% partial, 25% no response. Mean satisfaction level was 7 (range 0-10, 10 highest). Outcome was better with local anesthetic (complete response 75%) as it permitted more aggressive treatment. Patients that had both anesthetic and repeat treatment sessions experienced 92% complete response.

PDL + BI offers a novel method for treatment of recalcitrant warts, but local anesthetic and repeat treatments are recommended.