For the treatment of plantar warts, the use of microneedling followed by bleomycin spraying is associated with higher clearance rates and has proven to be less painful than the use of intralesional bleomycin injections, according to the results of a recent study conducted in Cairo, Egypt, and published in the Journal of Cosmetic Dermatology.

The investigators sought to compare the results of 2 different types of treatments for plantar warts. A total of 60 patients were enrolled in the study and were divided into 2 groups, with 30 patients in each group: group A received intralesional bleomycin with a single injection, using a syringe needle; group B received a combination of microneedling plus topical spraying of bleomycin, which was followed by occlusion for 2 hours.

In group A, the mean patient age was 24.5±8.06 years (range, 15-40 years); 73.3% of the participants were men. In group B, the mean patient age was 26.63±8.06 years (range, 15-40 years); 60.0% of the participants were men. Baseline characteristics, including sex, age, size of warts, and duration of warts, were statistically similar between the 2 groups.

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Overall, in group A, 70% (21 of 30) of participants exhibited complete clearance of their lesion or lesions, and 30% (9 of 30) of patients experienced partial clearance. In contrast, 83.3% (25 of 30) of participants in group B reported complete clearance of their lesions or lesions, and 16.7% (5 of 30) of patients had partial clearance. Other than pain, erythema, and transient induration, the occurrence of adverse effects was relatively uncommon. There were no nail changes or reports of Raynaud’s phenomenon in either group.

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The investigators concluded that the use of microneedling combined with bleomycin spraying had a favorable safety and efficacy profile for the treatment of plantar warts. The procedure was associated with higher clearance rates and was less painful than the use of intralesional bleomycin injections. Additional studies in larger populations are warranted, with long-term follow-up needed to evaluate possible recurrences and long-term efficacy.


Al-Naggar MR, Al-Adl AS, Rabie AR, Abdelkhalk MR, Elsaie ML. Intralesional bleomycin injection vs microneedling-assisted topical bleomycin spraying in treatment of plantar warts [published online April 23, 2018]. J Cosmet Dermatol. doi: 10.1111/jocd.12537

This article originally appeared on Dermatology Advisor