ABSTRACT
BACKGROUND: Viral warts affect 7~10% of the population and are a major burden on time and resources for all dermatology departments. There are currently various treatment modalities available, including cryotherapy, laser therapy, immune therapy, and topical keratolytics. However, some warts have proven to be resistant to these multiple therapies. Bleomycin has shown to be effective on these warts, but its injection can be difficult because of risk of local complications. OBJECTIVE: We compared the cure rate, efficacy, tolerability, side effects, and practicality of pulsed dye laser immediately followed by intralesional bleomycin treatment compared to treatment by intralesional bleomycin alone. METHODS: This study is a randomized controlled trial. Twenty-four patients, all with recalcitrant viral periungual warts of at least 2 years duration, were recruited. Twelve patients were treated with pulsed dye laser followed by intralesional bleomycin injection, and the other 12 patients were treated with intralesional bleomycin injection alone. RESULTS: All warts were cleared in all patients. There was no significant difference in the mean treatment number and the mean number of nail changes between the two groups. However, there was a significant decrease in the VAS score and the size of hemorrhagic blistering, involving the surrounding normal skin, in the combined pulsed dye laser and intralesional bleomycin group. In addition, the combined therapy enabled physicians to inject bleomycin more easily and safely. CONCLUSION: The combined method of pulsed dye laser and intralesional bleomycin appears to be a safe, effective and well tolerated treatment for recalcitrant periungual warts.