Warts are rough, scaly, spiny
papules or nodules. They can be exist on any cutaneous surface and they are a
manifestation of human papillomavirus (HPV) infection. There is no treatment,
which is 100% effective and different types of treatment can be utilised. 16% Salicylic acid is the best option which is suggested due to evidence based analysis and for second line treatment cry therapy is suggested. Bleomycin is
considered as third line therapy, especially encouraged for resistant warts to
conventional methods. According to the modified evidence based medicine system,
bleomycin has been regarded as level 1 strength of evidence for the treatment
of warts.
Bleomycin is derived from ‘Streptomyces verticillus’ and has an
antiviral activity by inhibiting DNA synthesis. Since 1970s, numerous reports
have been published on the use of intralesional bleomycin for the treatment of
warts, with cure rates ranging from 14% to 99%. Another administration
procedure of bleomycin is utilising multipuncture technique which is also thought
to be safe and effective. Very few studies are available about this technique of bleomycin administration in the current literature. There is no consensus
about procedure for application, the frequency of application, concentration
and dosing schedule. In this presentation, , we report a case which responded
to multi puncture administration of bleomycin for her recalcitrant plantar
warts and multi puncture technique for warts so far are summarized and
compared.