Bleomycin Treatment for Wart Removal

Bleomycin, also known as bleomycin sulfate, intralesional bleomycin or Blenoxane, is an anti-cancer drug that can be used to remove warts. It tends to be offered when all other wart removal treatments have failed. Bleomycin is also sometimes used as a treatment remedy when warts are difficult to remove surgically because they are in a hard to treat and reach locations like under the fingernails and with mosaic plantar warts.

Intralesional bleomycin is an antibiotic produced by the bacterium Streptomyces verticillus and acts by inhibiting DNA synthesis in cells and viruses; it breaks up strands of the DNA molecule to prevent the replication of cells. The human papillomavirus (HPV) that infects the skin and causes the wart will die as its DNA is chopped up by the intralesional bleomycin. It is also possible that the intralesional bleomycin may also target the blood vessels that feed the wart.

How to Use Intralesional Bleomycin with Warts

Please take note that intralesional bleomycin may only be applied by experienced health professionals in the usage of chemotherapeutic medications. At all costs, avoid injecting intralesional bleomycin all by yourself or doing it at home with inexperienced people. Just before the wart is injected with intralesional bleomycin, it is prepared first by peeling of the wart with a scalpel.

Intralesional bleomycin is usually diluted in a 1-milliliter saline solution or 1% lignocaine (anesthetic) and then injected directly into the wart, the area having at first been anesthetized with a local anesthetic only when intralesional bleomycin is not combined with lignocaine. A local anesthetic is needed because it has the ability to disrupt cell membranes and intralesional bleomycin does not penetrate cell membranes well.

At times, impulses of electricity are added with the help of electrodes, which are placed around the injected area, to be able to increase chances for intralesional bleomycin to be effective, which is a method known as electrotherapy. The aim is to achieve blanching or the act of removing the natural skin color. A blood blister soon forms with the wart on the roof of the blister. The wart turns black and after a few weeks, the wart falls off or can be removed by a doctor with the use of a scalpel.

Doctors normally use the combination 1ml tuberculin syringe and an insulin syringe, because the surface of warts sometimes show leaking of the solution injected. The normal volume injected for every treatment is between 0.1 ml to 2 ml. Any more than that can cause higher risks in side effects.

Additional injections may need to be given every three or four weeks until clearance has been achieved. Intralesional bleomycin is not absorbed into the body and so it does not produce any of the side effects usually associated with chemotherapy such as hair loss or lung complications.

Disadvantages of Using Intralesional Bleomycin as a Wart Remedy

The major disadvantage of intralesional bleomycin in terms of treating warts is that it can be painful, and several side effects have been reported by patients including scarring, nail damage, change in skin pigmentation, and skin irritation.

However, it can be a very effective treatment. Intralesional bleomycin wart treatments can also be very expensive. Even after studies and clinical trials have been made, the treatment is still not approved by USFDA or with Medsafe in New Zealand.

Intralesional Bleomycin Success Rates

One study showed that a 92% clear up rate was achieved when the antibiotic was injected directly into the wart (Munn SE, Higgins E, Marshall M, Clement M. A new method of intralesional bleomycin therapy in the treatment of recalcitrant warts. Br J Dermatol 1996; 135: 969-71).

The researchers were treating intractable palmar, plantar, and periungual warts. First, a topical local anesthetic was applied to the affected area and then 1 mg/ml intralesional bleomycin solution was dropped on to the wart and injected into it via a needle. The success rates compared favorably with other studies that had demonstrated positive outcomes in 33%-92% of cases.

When compared with cryotherapy treatment for wart removal, intralesional bleomycin comes out even more effective. In a 2003 study (H Adalatkhah et al. Compared therapeutic efficacy between intralesional bleomycin and cryotherapy for common warts: A randomized clinical trial. Dermatology Online Journal 13 (3): 4) scientists observed that when the two procedures were compared on 44 patients over 12 years of age, the mean clear up rate for intralesional bleomycin on hands and feet was 91.8% and for cryotherapy it was 76.1% – a statistically significant difference. There have been a few reports that show success in treating genital warts.

Side Effects of Intralesional Bleomycin Wart Treatment

The immediate side effects are swelling and redness due to the injection. A feeling of burning and pain may be felt right after injecting the solution. The pain may remain for up to 3 days at most. The intralesional bleomycin treatment is painful because there are times when multiple injections are necessary. This becomes even more painful for children.

The good thing is that it’s coupled with general or local anesthetics or anesthetic creams to reduce pain. The pain with intralesional bleomycin treatment is more bearable than cryotherapy. Four weeks after the treatment, a black scab may appear on the treated area which is a positive sign that treatment was effective and also indicates dead tissue and separation of a wart from the skin.

You will rarely have side effects such as narrowing of fingertips. Another seldom reported is restricted nail growth that can cause nails to be damaged or lost with pigments appearing. Uncommonly, inflammation of lymphatic vessels may occur and the development of hematoma, which is swelling on a certain area of the skin because of blood collection on the injected area. This is possibly due to injecting too deep during the treatment.

Patients with connective tissue or peripheral vascular disease are not advised to be treated with intralesional bleomycin as the treatment has a risk of having Raynaud phenomenon, which is when your arteries get spasms that cause incidents of decreasing blood flow. Symptoms of numbing of fingers and toes occur, and the appearance of finger and toes becomes white in color.

The use of intralesional bleomycin is also not recommended to pregnant and lactating patients because the drugs could go to the baby’s system and will negatively affect the infant’s health. During some clinical trials, it showed birth defects when intralesional bleomycin was injected on pregnant mice.

Other Uses of Intralesional Bleomycin

There are also other skin conditions where intralesional bleomycin is tested and showed efficacy. Some of these skin conditions are vascular anomalies like lymphatic malformations and haemangiomas. There has been some success with primary skin cancers such as keratoacanthoma and Bowen disease which have had instances of success with intralesional bleomycin supported with electrotherapy.

Cutaneous leishmaniasis, also known as oriental sore, has a few successful reports with regards to successful treatments with intralesional bleomycin, but it isn’t scientifically proven to be effective in treating such diseases. In the case of metastatic cancers, or cancers that have already spread all over the body, intralesional bleomycin is not used for treating the disease but is only used as a form of relieving the symptoms.

Other Dr. Treatments for Warts

Aside from bleomycin, https://warts.org/wart-removal lays out many types of wart remedies that are doctor administered and proven successful such as immunotherapy, laser removal, and cryotherapy.