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

Background 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. Objective To evaluate PDL + BI for the treatment of poor prognosis hand and foot warts. Study Design/Patients and Methods 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). Results 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 cm2, 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. Conclusion PDL + BI offers a novel method for treatment of recalcitrant warts, but local anesthetic and repeat treatments are recommended. Lasers Surg. Med. 46:112–116, 2014. © 2013 Wiley Periodicals, Inc.