Dermatography with bleomycin as a new teatment for verrucae vulgaris

Background: Common warts are caused by infection with human papillomaviruses (HPVs). Many, largely ineffective, treatment modalities have been tried in the past. The cytostatic drug bleomycin has been found to selectively affect squamous cell and reticuloendothelial tissue, but the method of its delivery directly into affected tissue such as warts has been of little efficacy. This study assessed the efficacy of a new mode of intralesional administration of bleomycin by dermatography. Methods: The warts of patients were treated with increasing concentrations of bleomycin using the van der Velden Derma-injector, a modified tattooing machine, under local or block anesthesia. The effects of the procedure were evaluated 1, 24, and 48 h later and the patients followed for up to 2 years. Results: Thirteen patients with warts on the hands and/or feet, resistant to conventional therapy, were entered into the study, and two patients dropped out. Of the 11 remaining patients, seven went into full remission that was maintained for at least 2 years. One patient showed moderate progress and in three patients little progress was noted and dermatography was stopped. The dosage of bleomycin varied between 0.1 and 1.0 mg/mL. Conclusions: Dermatography proved to be an effective technique for intralesional administration of bleomycin in more than two-thirds of patients resistant to conventional therapy. Treatment failures in this study could in part be explained by a defective immune system in the patients. Dermatography is a technique that can be learned by any skillful dermatologist or plastic surgeon.