Therapeutic effect of bleomycin tattooing combined with trichloroacetic acid and shaving on treatment-resistant plantar warts

Background: Bleomycin is used for the treatment of warts. However, only its injected form can be used due to systemic use side effects, and plantar warts have a high recurrence rate following administration of bleomycin tattooing alone. To find an effective alternative with fewer side effects, we decided to investigate the effectiveness of bleomycin tattooing combined with trichloroacetic acid (TCA) and shaving in the management of treatment-resistant plantar warts. Methods: The patients with treatment-resistant plantar warts entered the present quasi-experimental study. the wart site was shaved ahead of bleomycin tattooing and TCA peeling. This treatment was provided at one-month intervals and was repeated a maximum of four times. Patients were followed for six months after completion of the therapy. Finally, the patients’ data were completed according to photographs (monthly photos taken of lesions) and careful examinations. Results: The present study involved 56 patients with a mean age of 25.75 ± 12.22 years. Twelve patients (21.4%) recovered after the first treatment; 14 (25%) needed the second treatment, 12 (21.4%) needed the third, 10 (17.9%) the fourth, and eight (14.3%) did not recover after the fourth treatment. The recovery rate was 21.4% with one, 45.4% with two, 66.8% with three, and 85.7% with four treatment sessions. Conclusion: The combination treatment of bleomycin plus TCA and shaving led to a remarkable recovery from treatment-resistant plantar warts (21.4% recovery with the first treatment session and up to 85.7% recovery after four sessions). The treatment included tattooing and local injections, leaving few side effects.