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


  • Joelle S. Dobson MBBS,

    Corresponding author
    1. St.George's University of London, Cranmer Terrace, London, UK
    Current affiliation:
    1. The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, Gayton Road, King's Lynn
    • Correspondence to: Dr. Joelle Dobson, MBBS, St.George's University of London, Cranmer Terrace, London SW17 0RE, UK.

      E-mail: jsdobson@doctors.org.uk

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  • Christopher C. Harland FRCP

    1. Sk:n, Epsom and St.Helier University Hospitals NHS Trust, Sutton, Surrey, UK
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  • Acknowledgements of grant or other research funding: none.
  • “Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.”



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.


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).


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.


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.